Background: “Dhat syndrome” is believed to be a culture-bound syndrome of the Indian subcontinent. Although many studies have been performed, many have methodological limitations and there is a lack of agreement in many areas. Aims: The aim is to study the phenomenology of “Dhat syndrome” in men and to explore the possibility of subtypes within this entity. Settings and Design: It is a cross-sectional descriptive study conducted at a sex and marriage counseling clinic of a tertiary care teaching hospital in Northern India. Materials and Methods: An operational definition and assessment instrument for “Dhat syndrome” was developed after taking all concerned stakeholders into account and review of literature. It was applied on 100 patients along with socio-demographic profile, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Mini International Neuropsychiatric Interview, and Postgraduate Institute Neuroticism Scale. Statistical Analysis: For statistical analysis, descriptive statistics, group comparisons, and Pearson's product moment correlations were carried out. Factor analysis and cluster analysis were done to determine the factor structure and subtypes of “Dhat syndrome.” Results: A diagnostic and assessment instrument for “Dhat syndrome” has been developed and the phenomenology in 100 patients has been described. Both the health beliefs scale and associated symptoms scale demonstrated a three-factor structure. The patients with “Dhat syndrome” could be categorized into three clusters based on severity. Conclusions: There appears to be a significant agreement among various stakeholders on the phenomenology of “Dhat syndrome” although some differences exist. “Dhat syndrome” could be subtyped into three clusters based on severity.

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Background: Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS) characterized by mood changes, anxiety, and somatic symptoms experienced during the specific time of menstrual cycle. Prevalence data of PMS and PMDD is sparse among college girls in India. Aims: The aim of this study is to study the prevalence of PMS and PMDD among college students of Bhavnagar (Gujarat), its associated demographic and menstrual factors, to rank common symptoms and compare premenstrual symptom screening tool (PSST) with Structured Clinical Interview for DSM-IV-TR defined PMDD (SCID-PMDD) for sensitivity and specificity. Materials and Methods: A cross-sectional survey was done in five colleges of Bhavnagar. Of 529 subjects approached, 489 college girls were finally analyzed for sociodemographic data, menstrual history, and PSST. SCID-PMDD was applied among those who were positive on PSST and 20% of those who were negative. The data were analyzed using OpenEpi Version 2. Chi-square test was done for qualitative variables and analysis of variance for quantitative variables. Sensitivity, specificity, and predictive values were calculated for PSST. Results: The prevalence of PMS was 18.4%. Moderate to severe PMS was 14.7% and PMDD was 3.7% according to DSM IV-TR and 91% according to International Classification of Diseases, 10^th edition criteria. The symptoms commonly reported were “fatigue/lack of energy,” “decrease interest in work,” and “anger/irritability.” The most common functional impairment item was “school/work efficiency and productivity.” PSST has 90.9% sensitivity, 57.01% specificity, and 97.01% predictive value of negative test. Conclusion: Prevalence of PMS among college students is similar to other studies from Asia. PSST is a useful screening tool for PMS, and it should be confirmed by more specific tool as by SCID-PMDD. Routine screening with PSST can identify college girls who can improve with treatment.

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India ratified the United Nations Convention on the Rights of Person with Disabilities (UNCRPD) in 2007. This is a welcome step towards realizing the rights of the persons with disability. The UNCRPD proclaims that disability results from interaction of impairments with attitudinal and environmental barriers which hinders full and active participation in society on an equal basis with others. Further, the convention also mandates the signatory governments to change their local laws, to identify and eliminate obstacles and barriers and to comply with the terms of the UNCRPD in order to protect the rights of the person with disabilities, hence the amendments of the national laws. Hence, the Government of India drafted two important bill the Right of Persons with Disabilities Bill, 2014 (RPWD Bill, 2014) and Mental Health Care Bill, 2013 (MHC Bill, 2013). There is no doubt that persons with mental illness are stigmatized and discriminated across the civil societies, which hinders full and active participation in society. This situation becomes worse with regard to providing mental health care, rehabilitation and social welfare measures to persons with mental illness. There is an urgent need to address this issue of attitudinal barrier so that the rights of persons with mental illness is upheld. Hence, this article discusses shortcomings in the Right of Persons with Disabilities Bill, 2014 (RPWD Bill, 2014) from the perspective of persons with mental illness. Further, the article highlights the need to synchronize both the RPWD Bill, 2014 and Mental Health Care Bill, 2013 to provide justice for persons with mental illness.

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Background: Mentally ill prisoners, when requiring admission in a psychiatric facility, have to be admitted only by a reception order of a judicial magistrate and convicts by warrants issued by the Government to jail superintendents and the superintendent of the hospital. Both can be only under Section 27 of The Mental Health Act, 1987. Materials and Methods: A study of the contents of reception order and warrants regarding the acts and section under which they were issued over 1 year period for the admission of the patients in the criminal ward of the Institute of Mental Health was carried out. Results: Only three reception orders quoted Section 27 out of 54 patients admitted under a reception order. Nineteen patients were admitted by the jail superintendents. Discussion: Various issues that were found in the reception order and their consequences are discussed, and a possible response to these issues is mooted. Conclusion: Almost none of the reception orders were found to be proper. This deficit needs to be rectified by sensitizing the various authorities.

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Background: Some people in Northeast India prepare rice-based alcoholic drinks in the household. People use these drinks in religious and social functions, and these are taken even in the presence of parents and elders. Easy access to illicit substances in industrial towns and lack of social inhibition for intake of homemade alcohol might increase the vulnerability of youth to these habits. Objective: To estimate the prevalence of alcoholic drink user among school-going adolescent students in an industrial town of Assam. Materials and Methods: A cross-sectional survey was designed to collect the data using a predesigned questionnaire. Personal interview was conducted to collect the data about pattern of alcohol use, type of alcoholic drinks they use, duration, and information about parents and peer. Data were analyzed using Epi-info 17 and Statistical Package for Social Sciences-17.0 (Chicago, USA, SPSS Inc.). Results: About 36% out of 1285 students have tasted/used homemade alcoholic drinks (HADs) and 12.3% used commercially available alcoholic drinks (CADs). Significantly higher numbers (P < 0.001) of adolescent students (≥15 years) used CAD in comparison to children (<15 years). However, the number of younger students was higher in using HAD. Minimum age at first experience of CAD was 7 years and that of HAD was 4 years; the duration varied from 1 to 8 years and 1–15 years, respectively. Parent's behavior of taking tobacco and/or alcohol influenced the habit of their children. Father's habit was found to be associated with male offspring's habit of taking CAD. About 16% of the students used one or more substances along with alcohol. Conclusion: High percentage of adolescents in the industrial town of Assam use alcoholic drinks with a male preponderance. They taste alcoholic drinks at a very young age. Parent's indulgence in taking tobacco, alcohol, or both was found to influence higher intake by their offspring.

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This article refers to materials of psychiatric interest found in the Manimekalai written by the 2^nd Century CE Buddhist poet Sathanar. From the early description of a wandering psychotic in the streets of Pukar, the ancient maritime capital of the Cholas it is opined that this description fits that of present-day schizophrenia. A drunkard making fun of a Jain monk and a cross-dressed individual are also found in the same streets. Manimekalai's request to the Chola king to convert the prison to a place of piety with Buddhist monks is mentioned. Lord Buddha's teachings on the compassionate way of life are presented.

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Background: There is an intimate relationship between drugs and criminal behavior. The drug–violence relationship is further complicated by intoxicating doses and/or withdrawal effects of specific drugs. Understanding this relationship is important for both healthcare workers and policy makers. Materials and Methods: The study was conducted in Prayas observation home for boys, a short stay home for juveniles-under-enquiry in New Delhi. The present study aims to correlate substance use and criminal behavior by investigating the sociodemographic characteristics and the current trend of substance use among juveniles in New Delhi. In this study, 487 detained juveniles aged between 8 and 18 years were included. The information was obtained by face-to-face semi-structured interviews and juvenile case records maintained by the juvenile home. Results: Out of 487 juveniles-under-enquiry booked under different crimes, 86.44% of the sample had a history of substance use. Consumption of tobacco and cannabis were higher when compared to other drugs. Consumption of psychotropic drugs though relatively lesser was related with more serious crimes. There is an increasing trend in serious crimes such as rape, murder/attempt to murder, and burglary committed by juveniles. Drug-crime correlation has been noted among consumption of cannabis with murder, inhalants with rape and opioids with snatching-related crimes. Conclusion: Substance use and criminal behavior are clearly interrelated. Greater the involvement in substance abuse, more severe is the violence and criminality. This paper highlights this complex relationship and suggests possible scope of interventions.

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Context: Lack of literature on psychological aspects of survivors of farmers' suicides is hurdle in devising effective helping strategies for rising number of survivors across the country. Aims and Objectives: To assess the psychological distress and its correlates in survivors of farmers' suicides. Settings and Design: Case–control study design was used in Wardha District of Vidarbha region in the central India. Materials and Methods: A predesigned and pretested semistructured questionnaire was used to assess sociodemographic variables. Self-Reporting Questionnaire-20 was used to evaluate psychological distress in 98 survivors of farmers' suicides and 98 age, sex, and occupation-matched controls. Statistical Analysis: Significance of differences between case and control groups were assessed using Chi-square test or Fisher's two-tailed exact test for class variables. For continuous variables, Student's t-test was used P < 0.05 was considered significant. Results: Significantly higher proportion of survivors had psychological distress than controls. Female survivors, spouse and parents of suicide victims had a high risk of distress. Psychological distress was commonly expressed by depressive and somatic symptoms. Conclusions: Survivors of farmers' suicides are suffering from significant psychological distress.

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Context: Although electroconvulsive therapy (ECT) is considered a very effective tool for the treatment of psychiatric diseases, memory disturbances are among the most important adverse effects. Aims: This study aimed to assess prospectively early subjective memory complaints in depressive and manic patients due to bilateral, brief-pulse ECT, at different stages of the treatment, compare the associations between psychiatric diagnosis, sociodemographic characteristics, and ECT characteristics. Settings and Design: This prospective study was done with patients undergoing ECT between November 2008 and April 2009 at a tertiary care psychiatry hospital of 2000 beds. Materials and Methods: A total of 140 patients, scheduled for ECT with a diagnosis of bipolar disorder (depressive or manic episode) or unipolar depression according to Diagnostic and Statistical Manual of Mental Disorders IV diagnostic criteria, were included in the study and invited to complete the Squire Subjective Memory Questionnaire (SSMQ) before ECT, after the first and third sessions and end of ECT treatment. Statistical Analysis: Mean values were compared with the Kruskal–Wallis test and comparison of the longitudinal data was performed with a nonparametric longitudinal data analysis method, F1_LD_F1 design. Results: SSMQ scores of the patients before ECT were zero. SSMQ scores showed a decrease after the first and third ECT sessions and before discharge, showing a memory disturbance after ECT and were significantly less severe in patients with mania in comparison to those with depression. Conclusions: These findings suggest an increasing degree of subjective memory complaints with bilateral brief-pulse ECT parallel to the increasing number of ECT sessions.

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Context: Aggression and negative affectivity (NA) are known for moderating relationship between job stressors and counterproductive work behavior. Yoga has been demonstrated earlier to reduce the parameters of aggression and negative emotions. Aim: The present study examined the effectiveness of yoga practices in reducing counterproductive work behavior and its predictors such as aggression and NA. Settings and Design: A pretest–posttest randomized controlled design. Materials and Methods: The study sample included yoga group (n = 80) and control group (n = 80). Yoga module that included asanas, pranayama, meditation, and yogic theory were taught to the yoga group. Mild to moderate physical exercises and management theories were taught to the control group. Both groups received intervention for 10 weeks, covering 1 h daily, 5 days a week. Measurements of self-reported counterproductive work behaviors, aggression, and NA were taken as baseline and postintervention for assessment. Results: Yoga group reported significant reductions in aggression, NA, and counterproductive work behavior in comparison with the control group after 10 weeks. Conclusions: This study contributes by introducing a cost-effective way to prevent the heavy losses organizations are incurring due to counterproductive work behavior and its predictors. The findings support that yoga at workplace may result in positive psychological empowerment of the employees as well.

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Background: Early intervention programs for psychosis are gateways for suicide prevention. These programs offer an excellent opportunity for prevention due to easy access, early identification, and provisions for continuity of care. These programs have been found effective in reducing rates of suicide after discharge to communities. The objective of this study was to examine suicide risk level among early psychosis patients admitted with and without previous suicide attempts. We hypothesized that all patients admitted with early psychosis would be at high risk of suicide, regardless of a previous suicide attempt. Methodology: Suicide risk was compared between patients admitted with a suicide attempt (n = 30) and patients admitted without a suicide attempt (n = 30). The primary outcome measure of interest was suicide risk which was measured with the Scale for Impact of Suicidality–Management, Assessment and Planning of Care clinical interview. All patients met DSM-IV TR criteria for schizophrenia. Psychopathology was assessed using the Brief Psychiatric Rating Scale and level of depression was assessed using the Hamilton Depression Rating Scale. The data were statistically analyzed. Results: Patients admitted with a previous attempt (mean = 29.5, standard deviation [SD] =12.0) did not differ significantly in suicide risk from those admitted without a previous attempt (mean = 27.5, SD = 12.5), (t[58] =0.63, P = 0.53). Patients admitted without a suicide attempt scored higher in depressive symptoms (t[58] =10.62, P< 0.001) than that of admitted with a suicide attempt. There were no significant differences between patients admitted with and without suicide attempts on any comorbidity, other than a trend toward a higher prevalence of personality disorder in patients with no suicide attempt. Attempters and nonattempters did not differ on any demographic variables either. Conclusions: Of those admitted without a previous suicide attempt, our findings suggest that it is critical that all patients discharged from an acute psychiatric unit must receive comprehensive community care. The identification of risk, and subsequent intervention for suicidal and self-harm behaviors, should be a central part of treatment for all mental disorders.

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The Burgholzli Hospital Zurich has a very important place in history, as part of of modern era in Psychiatry. Founded in 1870 by the efforts of Griesinger, it was here many eminent path breakers in Psychiatry like Bleuler, Jung, Adolf Meyer and others once worked. From here, Bleuler coined the term “Schizophrenia”. Now the University Hospital of Zurich, Burgholzli's transformation from a mental hospital to a centre of excellence speaks of a rich legacy. It is a model worth emulating in many parts of the world.

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Background: Opioid dependence remains a significant problem in India, and of late intravenous (IV) buprenorphine use has increased in India, especially in combination with antihistamines and benzodiazepines. Its usage has many serious consequences in the form of needle-transmitted hepatitis and HIV, which is showing an increasing trend. Buprenorphine is a partial agonist at μ-opioid receptors. In tablet form (and rarely as IV), it is widely used in the treatment of opioid detoxification. We assessed the safety and efficacy of transdermal patch of buprenorphine with week long duration of action in the treatment of detoxification of IV buprenorphine dependence in view of its many advantages. Materials and Methods: Six consecutive patients with International Classification of Diseases diagnosis of Opioid Dependence Syndrome (IV buprenorphine) were given a buprenorphine patch for treatment of withdrawal symptoms after receiving consent. Severity of opioid dependence was assessed by using Severity of Opioid Dependence Questionnaire on the day of presentation. Subjective and objective rating for opioid withdrawal was done by subjective opiate withdrawal scale (SOWS) and objective opiate withdrawal scale (OOWS) prepatch and postpatch 3^rd and 7^th day. Buprenorphine side effect checklist was applied on a daily basis. Results: The patients had a mean age of 30 years, of whom 83.3% are males. All were educated and 50% were currently employed. All of them had additional comorbid substance use as well as a comorbid psychiatric diagnosis. Each of them received a patch of varying dosage. The patch dose used initially was based on clinical considerations alone and was fairly adequate in controlling acute withdrawal symptoms. There is a significant improvement in SOWS and OOWS while comparing the baseline (prepatch) with 3^rd and 7^th day (postpatch) (P ≤ 0.05). None of the patients reported any side effect with the patch. Conclusion: This study shows that transdermal buprenorphine is safe, useful, and clinically effective, and a 7-day application may provide an alternative means of detoxification. However, the result of the study needs to be replicated in a larger sample in a clinical setting, and a control group receiving a conventional mode of treatment needs to be included.

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“Unmodified”-electroconvulsive therapy (ECT) being considered unethical remained away from the scientific literature, but continued in practice in many parts of the world. The Mental Health Care Bill, 2011, proposed for its banning in India. The aim of this study is to retrospectively observe “how bad was unmodified-ECT” to the patients in a naturalistic setting. The study was done at the Central Institute of Psychiatry, India. Files of patients receiving unmodified ECT during 1990–1995 were retrospectively reviewed. Outcome was evaluated in terms of desired effectiveness and the side effects as noted in the files by the treating team. Six hundred and thirty-seven patients (6.94% of total admission) received ECT with meticulous standard-of-care except provision of anesthesia. Satisfactory improvement was noted in 95.45% patients with no noticeable/reported complication in 89.05%. Premature termination of ECT for complications occurred in 2.19% patients. “Unmodified”-ECT, though unethical, still could ensure favorable outcome with proper case selection and meticulous standard-of-care.

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Background: There are widespread perceptions that excessive and unnecessary investigations are done in many patients with mental illnesses. There are no studies from India looking into this issue. Aims: (i) To study the frequency and pattern of various investigations such as electroencephalography (EEG), computerized tomography (CT) scan of head, magnetic resolution imaging (MRI) scan of brain, and blood investigations carried out by the previous doctors on patients seeking treatment in three different settings. (ii) To study the socio-demographic and clinical correlates of investigations carried out on these patients. Study Design and Settings: A cross-sectional study in a community outreach clinic, a district level psychiatric hospital, and psychiatry outpatient clinic of a medical college. Materials and Methods: 160 newly registered patients seeking treatment at these settings were assessed using a semi-structured pro forma regarding various investigations that they had undergone before seeking the current consultation. Frequency of investigations was analyzed. Results: About 47.5% of patients had at least one of the three brain investigations done. EEG, CT head, and MRI brain had been done in 37.5%, 20.0%, and 8.8% of the patients, respectively. Only 1.8% of the patients had blood tests done before current consultation. Conclusion: This study results raise question whether certain investigations such as EEG and CT head were carried out excessively and blood investigations were done infrequently. Further studies on larger samples with prospective study design to evaluate the appropriateness of current practices of carrying out investigations in patients presenting with psychiatric symptoms are required.

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Purpose: This study is to assess the attitude of the medical interns toward psychiatry, psychiatrists and patients with mental health problems. Materials and Methods: A personal data sheet and the Balon et al. questionnaire was used to assess the attitude among medical interns (n = 44) of a medical college in Northern Kerala. Results: There was modestly good attitude toward psychiatry throughout the study. Data were compared between interns who have completed their posting in psychiatry and those who have not. There was no significant difference except for their awareness about consultation liaison services and the authoritative power of psychiatrists in mental health field. The stigma toward psychiatry is on the decline at least among medical professionals, and more interns are interested in taking up psychiatry as a future specialty. Conclusion: Although the study has evidenced a positive attitude to psychiatry, there is still room to improve. A clearer picture could be attained by conducting similar studies in a bigger sample size. A structured curriculum and compulsory internship during the undergraduate course have greatly contributed toward building a more positive opinion of the subject.

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Background: Efficacy and adverse effects of electroconvulsive therapy (ECT) depend on the extent to which the electrical stimulus exceeds patients' seizure thresholds (STs). Titration method of estimating ST is recommended. Age and co-prescribed anticonvulsants (ACs) are known to affect ST. Literature on ST in bilateral ECT (BLECT) is sparse. Objective: To explore the clinical and demographic determinants of ST in a clinically representative sample of patients prescribed with BLECT. Materials and Methods: ECT records of 640 patients who received BLECT in 2011 in an academic psychiatric setting were studied. Demographic, clinical, pharmacological, and ECT details were analyzed. As per the standard practice, during the 1^st ECT session, ST was determined by titration method, starting with 30 milli-Coulombs (mC) and increasing by 30 mC and thence in steps of 60 mC. Increase in ST over up to 6^th session of ECT was noted. Receiver operating characteristic curve was used to find age cut-off with high specificity for ST ≥120 mC. The associations of ST and increase in ST with the age cut-off and other clinical factors were assessed using Chi-square test and logistic regression analysis. Results: The mean age was 30.98 years (+11.23 years) and mean ST at 1^st ECT session was 130.36 mC (+51.96 mC). There was significantly high positive correlation (r = 0.37, P< 0.001) between age and ST. Cut-off age of 45 years had high specificity: Only 4.6% of those older than 45 years had ST <120 mC. Higher proportion of patients on AC had ST ≥120 mC. These associations were seen even after controlling for potential confounds of each other using logistic regression analysis. The results were similar for increase in ST over the course of ECT. Sex, diagnosis, use of antipsychotics, antidepressants, lithium, and benzodiazepines (BZPs) had no effect on ST or its increase. Conclusions: For BLECT using brief-pulse stimulus, ST depends on age and use of AC. For patients above the age of 45 years, ST estimation may be started at 120 mC with least risk of using unduly higher stimulus. Other medications including BZPs have little influence on ST.

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Background: Negative attitude toward psychiatry (ATP) among medical students is a serious concern. Some studies have concluded that after training in the subject, attitude changes toward positive side. Currently in India, medical students have a less intense course without separate exam or binding to attend training whereas physiotherapy students have more intense course with separate subject exam and binding to attend training in psychiatry. Objective: To ascertain and compare the positive and negative ATP in final year MBBS students and final year physiotherapy (BPTh) students who have completed psychiatry curriculum. Methods: This is a cross-sectional study with semi-structured pro forma for sociodemographic variables and ATP-30 questionnaire to evaluate ATP of 94 medical and physiotherapy students each. Nonparametric methods were used for statistical analysis with appropriate tests of significance and P value was set at 0.05. Results: Mean ATP-30 score for medical students was 91.9 (standard deviation [SD] =7.0) and that of physiotherapy students was 105.8 (SD = 9.7), this difference in two groups was highly significant (Kruskal–Wallis H = 81.3, df = 1, P < 0.001). Of all medical students, 36 (41.4%) had negative attitude while only 2 (2.1%) of the physiotherapy students had negative ATP (χ² = 41.7, P < 0.001). Boys were 2.6 times more likely to have negative ATP than girls (relative risk = 2.6, P = 0.005). Conclusions: Physiotherapy students with intense and planned training in psychiatry as an exam subject have significantly more positive ATP than medical students.

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Dermatitis artifacta is a psychiatric disorder in which the patient deliberately produces self-inflicted skin lesions to satisfy an unconscious psychological or emotional need, often a desire to receive medical treatment. We present a case of a 20-year-old female with pain in abdomen, pain during urination, and multiple skin lesions, mostly in the reach of her dominant hand and in tongue. She gave a history of several episodes of similar illnesses with admission in various hospitals. She was improved with selective serotonin reuptake inhibitor, supportive and insight-oriented psychotherapy.

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