Aim: The aim of this study was to evaluate the treatment pattern and satisfaction with treatment provided to patients with Dhat syndrome. It was also aimed to study the follow-up rates and reasons for dropping out of treatment in patients with Dhat syndrome. Materials and Methods: Sixty-four subjects diagnosed with Dhat syndrome were prospectively contacted to evaluate treatment satisfaction and reason for dropout after 6 months of baseline evaluation. Sociodemographic, clinical details were recorded at initial intake and Sex Knowledge and Attitude Questionnaire was applied. After 6 months, information on treatment received, number of follow-up visits to the clinic and the outcome were extracted from the treatment records. Treatment satisfaction using Patient Satisfaction Questionnaire and reasons for dropping out from treatment were assessed by a telephonic interview. Results: Twenty-three patients were categorized as treatment completers, 14 as early drop-outs and 27 as late drop-out. The mean (standard deviation) number of visits over the period of 6 months was 3.81 (3.06). The outcome at 6 months was no change in 45.3%, improved in 32.8% and recovered in 21.9%. Higher proportion of treatment completers (52.2%) sought psychiatric help on their own compared to those who dropped out early from the treatment (7.1%). Treatment completers had better knowledge, and more positive attitude toward sex compared to late drop-out group. 34.4%of the subjects were fully satisfied with the various components of treatment. Level of satisfaction was highest for treatment completers. The most common reasons given by those who dropped out early were "not able to spare time for consultation" (21.4%) and "not prescribed medications" (21.4%). The most common reason given by those belonging to "late drop-out" group was 'no improvement with treatment in symptoms of Dhat syndrome (40.7%). Conclusions: Patients with Dhat syndrome frequently drop-out of the treatment network. There is a need to reorganize the services for these patients and understand their expectations from the treatment so as to provide better care.

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Aims: Human-tiger conflict (HTC) is a serious public health issue in Sundarban Reserve Forest, India. HTC is a continued concern for significant mortality and morbidity of both human and tiger population. This study examined 49 widows, whose husbands were killed by tigers, in order to explore the cultural stigma related with tiger-killing and consequent discrimination and social rejection. Different psychosocial aspects of community stigma associated with tiger-killings is discussed in the context of local culture. Methods: A mix of both quantitative and qualitative methods was used in this ethnographic study in two mouzas of Sundarban adjacent to Reserve Forest, involving (1) Village Survey for Tiger-widows, (2) In-depth interview of the widows, (3) Focus Group discussions, (4) Participatory mapping and (5) Stigma assessment by using a 28 item stigma scale especially devised for this research. For comparison of stigma-burden snake-bite widows and normal widows were taken from the same community. Results: Tiger-widows showed significantly higher stigma scores on all the clusters (fear, negative feelings, disclosure, discrimination, community attitudes, and spiritual dimension) than from both normal and snake-bite widows. They also showed higher total stigma score (65.9 ± 9.8) than normal widows (35.8 ± 8.0) and snake-bite widows (40.1 ± 7.1) and this difference was highly significant (P < 0.001). IDIs and FGDs helped to unfold the cultural construct of stigma related to tiger-killing. This can be seen in how the tiger-widows' quality of life has been negatively impacted with a multitude of post-trauma psychological scars, deprivation, abuse and exploitation. Conclusions: The study proposes that administrative strategy for sustainable alternative income generation and conservation policy with integrated participatory forest management may save both human and tiger. A community ecocultural mental health programme addressing to eradicate the cultural stigma related with tiger attack, with environmental awareness may help to reduce the social miseries of the tiger-widows.

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Context: Globally, psychiatry as a subject, psychiatrists as professionals, and patients with psychiatric disorders are subjected to cultural stereotypes and negative attitude by the general population. What is of alarming concern is that these prejudices exist within the medical community as well. Aims: This study aims at evaluating the perception, knowledge, and attitude toward psychiatric disorders, therapeutic modalities used in psychiatry, psychiatry as a subject and psychiatrists as professionals among undergraduate medical students in Karnataka. Settings and Design: This is a descriptive, cross-sectional type of study conducted in three medical colleges located in Karnataka. Materials and Methods: A sample of 500 students from all three professional phases of MBBS was selected using purposive sampling. A semistructured prevalidated questionnaire was used to assess the perception, knowledge, and attitude of undergraduate medical students toward psychiatric disorders and psychiatry. Statistical Analysis: Data were analyzed using Statistical Package for Social Sciences, version 16.0. Results: The undergraduate medical student population had significant shortcomings in knowledge and attitude pertaining to psychiatric disorders, more glaring in the initial years of education. A comparatively positive opinion was obtained regarding psychiatry as a subject and psychiatrists as professionals, which may reflect the changing trends and concepts, both in society and medical community. Conclusion: This study highlights the need for better educational measures at undergraduate level in order to shape a positive attitude of the health care providers towards psychiatry, which is essential for ensuring better care for patients as well as reduction of stigma surrounding psychiatric disorders.

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Understanding of psychopathology of mental disorder is evolving, particularly with availability of newer insight from the field of genetics, epigenetics, social, and environmental pathology. It is now becoming clear how biological factors are contributing to development of an illness in the face of a number of psychosocial factors. Resilience is a psychobiological factor which determines individual's response to adverse life events. Resilience is a human capacity to adapt swiftly and successfully to stressful/traumatic events and manage to revert to a positive state. It is fundamental for growth of positive psychology which deals with satisfaction, adaptability, contentment, and optimism in people's life. Of late, there has been a paradigm shift in the understanding of resilience in context of stress risk vulnerability dimension. It is a neurobiological construct with significant neurobehavioral and emotional features which plays important role in deconstructing mechanism of biopsychosocial model of mental disorders. Resilience is a protective factor against development of mental disorder and a risk factor for a number of clinical conditions, e.g. suicide. Available information from scientific studies points out that resilience is modifiable factor which opens up avenues for a number of newer psychosocial as well as biological therapies. Early identification of vulnerable candidates and effectiveness of resilience-based intervention may offer more clarity in possibility of prevention. Future research may be crucial for preventive psychiatry. In this study, we aim to examine whether resilience is a psychopathological construct for mental disorder.

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Substance abuse is an important health problem throughout the world including India, but prevalence and pattern of abuse varies from country to country and in different types of population. Slums have their own social and economic problems so that substance abuse may be different in this population and might be related with these problems. The aim of the present study was to study the prevalence and pattern substances in slum population. Prakash Chandra Sethi Nagar slum area of Indore district was selected for the purpose of this study. In first phase of the study, first a camp was organized to sensitize local leaders, key persons, and local inhabitants about drug abuse at Chandra Prakash Sethi Nagar. After that basic information was gathered with the key persons in Chandra Prakash Sethi Nagar. In second phase by house-to-house survey, all members of the family were interviewed in detail and information was recorded on semi-structured proforma. We observed prevalence rate of 560/1000 populations, 78.2% were males, 28.2% were females, and two-third abusers were laborers (72%). In order of frequency, tobacco was the most common substance abused in 53.9% population followed by gutka (nontobacco pan masala). Other drugs in order of frequency were alcohol 46.5%, cannabis 8.9%, opiates 4.9%, sedative and hypnotic 2.0%, solvents 1.0%, and cocaine in 0.1%. Slum population has higher prevalence rates than general population.

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Aim: The aim of this study was to evaluate the concept of female Dhat syndrome characterized by the complaint of nonpathological vaginal discharge in association with somatic, anxiety, and depressive symptoms. Materials and Methods: A total of 26 female subjects with nonpathological vaginal discharge along with depressive and somatic complaints were assessed on a self-rated questionnaire modified from Comprehensive Questionnaire for Assessment of Dhat Syndrome designed for males. They were also assessed for psychiatric comorbidity as per ICD-10. Results: All female subjects received an ICD-10 psychiatric diagnosis, with somatoform/dissociative disorder (57.7%) being the most common. The mean age of onset of vaginal discharge was 24.6 (standard deviation - 7.0) years, noted every day or for 2-3 times per week by more than two-third of the participants. Two-fifth (61.5%) of the women described it as a milky discharge. The most common reason reported for passage of vaginal discharge was that of urinary infection or problems of urinary tract infections (42.3%) followed by vaginal infection/disease (34.6%). More than half (53.8%) of the subjects considered vaginal discharge to be responsible for weakness in the body, weakness in stamina and thinness of physique, while slightly more than two-third (69.2%) of them reported bodily weakness and sleep disturbances. Overall the clinical picture in females was similar to male patients with Dhat syndrome on most of the account. Conclusions: Subgroup of patients with vaginal discharge attribute their somatic and mental symptoms to the passage of whitish vaginal discharge and are distressed due to the same. The clinical picture is similar to Dhat syndrome in males. There is a need to recognize female variant of Dhat syndrome as a culture-bound syndrome. Identification of the same may help in managing this subgroup of patients seeking help from the gynecologists for their nonpathological vaginal discharge or from mental health professionals for their symptoms of common mental disorders.

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Background: Alzheimer's disease is one of the debilitating chronic diseases among older persons. It is an irreversible condition that leads to progressive deterioration of cognitive, intellectual, physical, and psychosocial functions. The study was aimed to assess the knowledge of the family members of elderly regarding Alzheimer's disease in a selected urban community at Mangalore. Materials and Methods: A preexperimental research design of one group pretest and posttest with an evaluative approach was adopted for the study. A total of 50 family members of elderly who met the inclusion criteria were selected through purposive sampling technique. The researcher developed a planned teaching program on Alzheimer's disease, and structured knowledge questionnaire on Alzheimer's disease was used to collect the data. Results: Descriptive and inferential statistics was used to analyze the data. Analysis revealed that the mean posttest knowledge (20.78 ± 3.31) was higher than mean pretest knowledge scores (12.90 ± 2.43). Significance of difference between pretest and posttest was statistically tested using paired "t" test and it was found very highly significant (t = 40.85, P < 0.05). Majority of the variables showed no significant association between pretest and posttest knowledge score and with demographic variables. Conclusion: The findings revealed that the planned teaching program is an effective strategy for improving the knowledge of the subjects.

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Context: Multiple vulnerability genes interact with environmental factors to develop a range of phenotypes in the schizophrenia spectrum. Endophenotypes can help characterize the impact of risk genes by providing genetically relevant traits that are more complaisant than the behavioral symptoms that classify mental illness. Aims: We aimed to investigate the neurocognitive endophenotypic markers for schizophrenia in Indian population. Settings and Design: In a cross-sectional study, we assessed neurocognitive functioning in 40 unaffected first-degree relatives (FDR) of schizophrenia patients with an equal number of healthy controls. Materials and Methods: FDR schizophrenia group was compared with the control group on measures of short-term memory, verbal working memory, auditory verbal memory on indices of immediate recall and recognition, visuospatial working memory, visual attention, and executive functions. Results: The study found that FDR schizophrenia scored poorly on all tested measures of neurocognition except visual attention. On calculating composite score, we found that composite neurocognitive score better discriminated the FDR schizophrenia from the control group. Conclusions: Neurocognitive measures of short-term memory, verbal working memory, auditory verbal memory, visuospatial working memory, and executive functions significantly differentiate FDR of patients with schizophrenia from controls and can be considered as endophenotypic markers of schizophrenia in non-Caucasian population. The exactitude of this approach can be increased by calculating a composite neurocognitive score which combines various neurocognitive measures.

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Context: Retention in treatment can improve the outcomes of patients with substance use disorders. Aims: This study aimed to assess the predictors of treatment retention in a set of patients admitted with substance use disorders. Setting and Design: This record-based study was conducted among consecutive patients discharged from the inpatient unit of a tertiary care de-addiction facility in Northern India. Materials and Methods: Patients were classified as being retained in treatment or drop-outs based on follow-up records. Statistical Analysis: Those who were retained and those who dropped out were compared using appropriate parametric and nonparametric tests. Logistic regression was used to find out the predictors of retention in treatment. Results: A total of 88 case records were evaluated. All subjects were males and majority of the sample was married, educated up to 10 ^th grade, employed, belonged to the nuclear family and urban background. Opioid dependence syndrome (96.6%) was the most common substance use disorder identified. Guilt feelings, general weakness of body, and loss of social respect were the most common substance-related complications experienced. Of the total sample, 40 (45.4%) were classified as retained into treatment. Higher socioeconomic status and having a family member with substance use was associated with higher chances of treatment retention. Conclusion: Identification of patient characteristics predicting drop-outs can help in targeting those individuals at higher risk. This can help in more favorable patient outcomes.

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Background: Presleep thoughts may vary between patients of insomnia with or without depression. They are important for cognitive behavior therapy for insomnia (CBT-I), but they have never been systemically examined in Indian population. Materials and Methods: Patients with insomnia (>1 month) who were willing to undergo CBT-I were included in this study after obtaining informed consent. They were requested to fill a sleep diary and return after 15 days. At the time of intake, diagnosis of depression and anxiety disorders was made according to Diagnostic and Statistical Manual - IV-Text Revision. They were encouraged to provide information regarding presleep thoughts through open-ended and then, close-ended questions. Dysfunctional attitudes and beliefs about sleep were assessed with Hindi version of "dysfunctional beliefs and attitudes scale-brief version". Hindi version of "insomnia severity index" was used to assess the severity of insomnia. Subjects were divided into two-groups - insomnia without depression (I) and insomnia with major depressive disorder (I-MDD+). Statistical Analysis: It was done with the help of SPSS v 21.0. Descriptive statistics was calculated. Proportions between groups were tested with Chi-square analysis and categorical variables were compared using independent sample t-test. Results: This study included a total of 63 subjects, out of which 60% were women. Mean age of the whole group was 41.7 ± 11.8 years. About 40% of all the subjects were diagnosed as having I-MDD+. Forty-one percent of the subjects had clinically significant anxiety. Both groups - I and I-MDD+ had comparable proportion of female subjects (χ² = 0.002; P = 0.96) and there was no difference regarding precipitating factors for insomnia (χ² = 0.97; P = 0.61). They were also comparable with regards to sleep-related measures, themes of presleep thoughts, and dysfunctional beliefs and attitudes about sleep and insomnia severity. Major themes of presleep thoughts included family issues and health issues. Only a small proportion had recurrent thoughts related to insomnia and its consequences. Conclusion: Insomnia is a co-morbid illness with depression and it needs to be separately addressed during therapy. CBT-I should include the element of problem-solving technique, especially when we are dealing with the Indian population.

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In 1993, a device to administer brief-pulse electroconvulsive therapy was indigenously developed through collaboration between the National Institution for Quality and Reliability and the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India. The additional feature of computerized recording of the electroencephalograph and electrocardiograph for both online and offline use had substantial clinical and research implications. Over the past two decades, this device has been used extensively in different academic and nonacademic settings. A considerable body of research with clinical and heuristic interest has also emanated using this device. In this paper, we present the development of this device and follow it up with a review of research conducted at NIMHANS that validate the features and potentials of this device.

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Joubert syndrome is a rare autosomal recessive disorder with partial or complete agenesis of cerebellar vermis. This syndrome is identified mainly by the presence of molar tooth sign in magnetic resonance imaging of the brain since it has a varied phenotypic presentation. Of the 200 cases reported so far in the literature, only three reports show the presence of autistic symptoms in siblings suggesting a link between the cerebellar vermis and autistic spectrum disorders. In this case report of two siblings, the female child satisfied the criterion for autistic spectrum disorder in accordance with Diagnostic and Statistical Manual of Mental Disorders Fifth Editon. The boy showed developmental delay with autistic features (not amounting to diagnostic threshold). This report is important in that it adds evidence to the literature that abnormalities of cerebellum are involved in the cognitive development and autistic symptoms.

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Consumption of one or other form of intoxicating substances has been present throughout the history of the world. This article traces such use in the Indian subcontinent, both in North and South India. References to the use of intoxicants are to be found in the Vedas, the Great Epics, and the ancient Tamil literature.

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Background and Aim: Polymorphisms in aryl hydrocarbon receptor nuclear translocator-like (ARNTL) gene, the key component of circadian clock manifests circadian rhythm abnormalities. As seasonal affective disorder (SAD) is associated with disrupted circadian rhythms, the main objective of this study was to screen an Indian family with SAD for ARNTL gene polymorphisms. Materials and Methods: In this study, 30 members of close-knit family with SAD, 30 age- and sex-matched controls of the same caste with no prior history of psychiatric illness and 30 age- and sex-matched controls belonging to 17 different castes with no prior history of psychiatric illness were genotyped for five different single nucleotide polymorphisms (SNPs) in ARNTL gene by TaqMan allele-specific genotyping assay. Statistical Analysis: Statistical significance was assessed by more powerful quasi-likelihood score test-XM. Results: Most of the family members carried the risk alleles and we observed a highly significant SNP rs2279287 (A/G) in ARNTL gene with an allelic frequency of 0.75. Conclusions: Polymorphisms in ARNTL gene disrupt circadian rhythms causing SAD and genetic predisposition becomes more deleterious in the presence of adverse environment.

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Disorders of ejaculation are the consequences of surgical procedures and with the use of various drugs. Until date, most drugs reported to induce ejaculatory dysfunctions such as retrograde ejaculation or dry orgasms share the capacity to significantly antagonize alpha 1-adrenergic receptor. Iloperidone, a new dopamine Type 2 and serotonin Type 2A antagonist similar to risperidone, provides better efficacy with lesser extra-pyramidal side effects. In addition, it also antagonize alpha 1-adrenergic receptor and alpha-2C receptors. Limited data is available for iloperidone-induced ejaculation dysfunction. This article features five schizophrenic patients which developed retrograde ejaculation during treatment with iloperidone. The ejaculatory dysfunction following treatment with iloperidone could be postulated due to blocking of alpha 1-adrenergic receptor.

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