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CASE REPORTS
Compulsive masturbation in a patient with delusional disorder
Sagar Karia, Avinash De Sousa, Nilesh Shah, Sushma Sonavane
January-June 2015, 20(1):38-40
DOI:10.4103/0971-8990.164825  
Compulsive masturbation is a type of paraphilia related disorder in which a person engages in masturbatory behavior to such an extent that it causes socio-occupational dysfunction. The psychiatric co-morbidities associated with it include mood and anxiety disorders, substance use disorders, etc. Here, we report a case of a patient with the delusional disorder having compulsive masturbation.
  80,815 637 -
REVIEW ARTICLE
Strategies in clozapine-resistant schizophrenia: A literature review
Ganesh Kundadak Kudva, Dhanesh Kumar Gupta
January-June 2016, 21(1):6-15
DOI:10.4103/0971-8990.182096  
Treatment resistance to what is often deemed the last line of schizophrenia treatment, clozapine, is a burgeoning problem in psychiatric practice, with estimates of clozapine resistance standing at 40–70% of the treated population. This paper, a comprehensive review of available literature, looks at augmentation strategies to clozapine for such patients, with pharmacological and nonpharmacological modalities considered and reviewed. With a preponderance of open-label trials and case reports, our conclusion is that more research in this field via randomized clinical trials is crucial. Every case of clozapine resistance should be managed in an evidence-based and multidisciplinary manner, with augmentation only used once optimal dosage and duration of clozapine monotherapy is reached, and the psychosocial environment is optimized.
  13,212 1,088 1
INSPIRATIONS FROM HISTORY
The study of patient henry Molaison and what it taught us over past 50 years: Contributions to neuroscience
Bigya Shah, Raman Deep Pattanayak, Rajesh Sagar
July-December 2014, 19(2):91-93
DOI:10.4103/0971-8990.153719  
This section provides a historical perspective and contributions from one of the most studied patients in neuroscience, Henry Molaison (1926-2008), known as H.M during his life to protect his privacy. The peculiar memory deficits seen after an experimental operation for intractable epilepsy led to some critical discoveries pertaining to memory organization in human brain.
  7,683 607 -
ORIGINAL ARTICLES
Locus of control and its relationship with mental health and adjustment among adolescent females
Madhu Jain, Suyesha Singh
January-June 2015, 20(1):16-21
DOI:10.4103/0971-8990.164803  
Objective: There exists a plethora of researches which have identified the role of Locus of Control in maintaining sound mental health and adjustment. The present study examined the relationship of Locus of Control with Mental Health & overall Adjustment among adolescent females. Method: The participants consisted of 50 adolescent females. Mental Health Battery designed by Singh, Gupta (2000), Rotter's Locus of Control Scale (1966) & Adjustment Inventory for College Students by Sinha & Singh (1995) were administered. Findings: The findings of the study revealed that adolescent females who possess internal locus of control showed better mental health & overall adjustment pattern which includes home, social, emotional, educational domains and health adjustment domain than those who possess external locus of control. Conclusion: The study highlights the pervasive influence of internal & external locus of control on mental health & adjustment among adolescent females.
  6,460 307 3
INSPIRATIONS FROM HISTORY
The case of rat man: A psychoanalytic understanding of obsessive-compulsive disorder
Suresh Thapaliya
July-December 2017, 22(2):132-135
DOI:10.4103/jmhhb.jmhhb_22_17  
This article discusses case of Mr. Ernst Lanzer known as the “Rat Man” in the history of psychoanalysis. He was diagnosed as a case of obsessive-compulsive disorder by Sigmund Freud known as obsessional neurosis that time. The patient presented to Freud with number of distressing obsessions of which the main one was fear of a corporal punishment to his loved ones using rats. The patient underwent psychoanalytic treatment for his symptoms for 6 months following which he was declared cured. Freud has discussed the case in a published case note. Over the subsequent years, the case received wider attention from the psychoanalytic community and continues to be interpreted and discussed from different perspectives after nearly one century of his clinical interaction with Freud.
  6,174 481 -
CASE REPORTS
A case report of folie a deux: Mother and daughter
Nikita Dhaka, RK Solanki, GD Koolwal, Sanjay Gehlot, Surender Kumar
January-June 2016, 21(1):66-68
DOI:10.4103/0971-8990.182099  
Shared paranoid disorders, a relatively rare psychiatric disorder in which paranoid delusions are transferred from one individual to one or more other susceptible person(s) in close association. Folie a deux is characterized by a complex dependent relationship between the involved individuals, yet a challenging diagnosis. In the paradigm of changing nosology, where the term shared/induced psychotic disorder is going obsolete, it is important to recognize such cases due to the potential for recovery in the submissive partner. Here, we present a case report and discussion of folie a deux involving inducer mother and induced daughter. In the clinical case presented, folie á deux was easily diagnosed, but its treatment proved to be a bigger challenge.
  5,895 199 -
EDITORIAL
Child sexual Abuse: Need for a preventive framework in Indian context
Rajesh Sagar
July-December 2014, 19(2):53-55
DOI:10.4103/0971-8990.153710  
  3,853 1,989 -
ORIGINAL ARTICLES
Factors affecting marriage in schizophrenia: A cross-sectional study
Vikas Deshmukh, Aparna Bhagat, Nilesh Shah, Sushma Sonavane, Avinash Alan Desousa
July-December 2016, 21(2):122-124
DOI:10.4103/0971-8990.193432  
Background: Schizophrenia is a chronic psychiatric disorder which has a profound effect on the patient's life course. Marriage has been shown to be both protective and detrimental to the course of recovery in schizophrenia. The study was planned to elucidate the factors that influenced marriage and the sustainability of marriage in patients with schizophrenia. Materials and Methods: The study sample was 101 patients with schizophrenia that attended the outpatient department of tertiary general hospital. Informed consent was taken and data collected from the patients and/or relatives on a special semi-structured pro forma. The data collected were subjected to appropriate statistical analysis after further subdividing the sample into subgroups. Results: About 69.3% of the total samples were married while 30.7% were unmarried. A significantly greater number of patients who were educated were unmarried (P = 0.026). Age of onset of illness below 25 years (P = 0.002) was a significant factor in those who were unmarried. When marital outcomes were considered, it was noted that greater male patients had stable marriages though not statistically significant, whereas earlier age of onset of illness was a significant factor that resulted in poor marital outcome (t = 2.96, df = 68, P = 0.0021). Conclusions: The effect of marriage on schizophrenia and factors that may influence marital sustainability in patients with schizophrenia need further study and are multipronged. Larger studies in this area of research are warranted.
  5,508 256 -
INSPIRATIONS FROM HISTORY
Dorothea dix: A proponent of humane treatment of mentally ill
Tamonud Modak, Siddharth Sarkar, Rajesh Sagar
January-June 2016, 21(1):69-71
DOI:10.4103/0971-8990.182088  
The work of early pioneers like Dorothea Dix was instrumental in the establishment of institutions dedicated especially for the care of the mentally ill. Originally from the United States, she became acquainted with the idea of humane treatment of the mentally ill during her visit to England. After her return to the United States, she conducted a statewide investigation of care for the insane poor in Massachusetts and began to extensively lobby for reforms and establishment of more state-funded institutions for the care of mentally ill. Her efforts led to setting up of several mental health institutions, which became the cornerstone of care of psychiatrically ill, and for training of mental health care providers. Though subsequently, the hegemony of the institutions was challenged, and the era of deinstitutionalization was ushered in, the work of Dorothea Dix is important as it vouched for humane care of patients with mental illnesses.
  5,022 462 -
CASE REPORTS
Mucuna pruriens (Konch Beej) precipitates manic symptoms
Supriya Vaish, Sachin Sharma, S Sudarsanan, S Choudhary, Jai Meher Singh, Nafroz Khosla
July-December 2014, 19(2):85-86
DOI:10.4103/0971-8990.153717  
Owing to the popular misconception that all ayurvedic preparations are completely safe, a vast majority of these are indiscriminately consumed by people procured as over the counter drugs. These preparations are combinations of multiple products that are often unidentified and dangerous and can precipitate various psychiatric symptoms. Hereby, we present a case of adolescent male in acute manic excitement after consumption of ayurvedic preparation containing "konchbeej" (Mucuna pruriens) which is rich in l-3,4 dihydroxyphenyl alanine; precursor of dopamine.
  4,962 99 -
REVIEW ARTICLES
A systematic review of depression, anxiety, and stress among medical students in India
Siddharth Sarkar, Rishi Gupta, Vikas Menon
July-December 2017, 22(2):88-96
DOI:10.4103/jmhhb.jmhhb_20_17  
Background and Objectives: The vicissitudes and stresses of medical education in India have been suggested to be different from that of the Western world. Several studies have attempted to assess the psychological morbidity among medical students in India. This systematic review attempted to collate the findings relating to the prevalence of depression, anxiety, and stress among medical students in India. Materials and Methods: Studies were identified using PubMed, Embase, MedInd, and Google Scholar databases. Those studies conducted in India which reported the prevalence of depression, anxiety, and stress among the medical students were included. Pooled prevalence rate was calculated for depression, anxiety, and stress. Results: The prevalence rate of depression varied from 8.7% to 71.3%, while the pooled prevalence rate of depression from 16 studies (n = 3882) was 39.2% (95% confidence interval: 29.0%–49.5%). Similarly, the pooled prevalence rate of anxiety from four studies (n = 686) was 34.5% (95% confidence interval: 10.1%–58.9%), and the pooled prevalence rate of stress from 28 studies (n = 5354) was 51.3% (95% confidence intervals: 42.8%–59.8%). Female students had higher rates of depression and stress as compared to males. Conclusions: Depression, anxiety, and stress affect a considerable proportion of undergraduate medical students in India. Systemic efforts are needed to address their concerns and make mental health care easily accessible to them.
  4,175 613 -
EDITORIALS
Health insurance for mental health in India: A welcome step toward parity and universal coverage
RD Pattanayak, Rajesh Sagar
January-June 2016, 21(1):1-3
DOI:10.4103/0971-8990.182089  
  4,551 153 -
EDITORIAL
Suicidality and mood disorders: Gatekeepers' training and mental health first aid
Rajesh Sagar, Raman Deep Pattanayak
July-December 2016, 21(2):85-87
DOI:10.4103/0971-8990.193424  
  2,539 1,943 -
INSPIRATIONS FROM HISTORY
Tracing the journey of disulfiram: From an unintended discovery to a treatment option for alcoholism
Arghya Pal, Raman Deep Pattanayak, Rajesh Sagar
January-June 2015, 20(1):41-43
DOI:10.4103/0971-8990.164826  
Disulfiram is a drug that has been used as a deterrent agent in the treatment of alcohol use disorders. This section ventures into the journey of the discovery of the molecule, starting from the accidental discovery of its potential pathophysiological effects, thereafter becoming obscure due to lack of indications (alcohol use was not considered a problem!); and finally making a comeback and standing the rigorous test of time due to the determination of a few researchers, which makes it a story worth revisiting.
  4,208 161 2
DR. AK KALA AWARD PAPER
A comparative study of olanzapine versus asenapine in acute treatment of manic episode: A 3-week prospective study
Ajeet Sidana, Prannay Gulati, BS Chavan
July-December 2014, 19(2):56-61
DOI:10.4103/0971-8990.153711  
Introduction: Treatment of bipolar disorders has evolved over the years from conventional mood stabilizers to second-generation antipsychotics. Among the atypical antipsychotics, few have been approved by Food and Drug Administration as treatment of bipolar disorders. Aim: To study the efficacy and tolerability of olanzapine and asenapine in the acute treatment of bipolar disorder-manic episode in a 3-week randomized prospective study. Materials and Methods: A 3-week randomized, prospective, comparative, flexible doses of olanzapine (5-30 mg/day) and asenapine (10-20 mg/day) for acute treatment of bipolar disorder-current manic episode with or without psychotic symptoms in hospitalized patients. Results: The end-point reduction in mean score of Young Mania rating scale in the olanzapine group was 15.82 in comparison to 6.88 in the asenapine group. Mean score on clinical global impression for bipolar disorder and positive and negative syndrome scale was significantly less in the olanzapine group at the end of the study. 81.81% patients in olanzapine group and 17.60% patients in asenapine group had clinical response. There was significant average weight gain in the olanzapine group - 1.9 kg in comparison to 0.87 kg in asenapine group. Conclusion: The clinical response with olanzapine is significantly higher than the asenapine in the treatment of bipolar disorder-manic episode with or without psychotic symptoms. However, there is significant weight gain in olanzapine-treated patients.
  3,518 830 -
CASE REPORTS
A case of Fregoli syndrome and Erotomania associated with anemia
Hemendra Singh, Sundarnag Ganjekar, Prashanth B Ghandhi, Murali Thyloth
July-December 2014, 19(2):83-84
DOI:10.4103/0971-8990.153716  
Although anemia due to the cobalamin deficiency has been described as a cause of a wide range of psychiatric disorders, the role of iron deficiency anemia in psychiatric disorders remains unexplored. We report a rare case of simultaneous presence of simultaneous presence of Fregoli syndrome with Erotomania which occuring in the context of iron and cobalamin deficiency anemia. The index patient improved after correction of anemia. But what is notable is that the patient continues to be free from psychotic symptoms even after 4 months of discharge. This case report shows a rare combination of two different delusional disorders that might be associated with anemia. This stresses the importance of doing a complete hematological work up in patients with psychiatric disorders.
  3,956 113 -
Unusual manifestation of therapeutic dose of lithium as syndrome of irreversible lithium-effectuated neurotoxicity
Hemendra Singh, Sundernag Ganjekar, Anand Kalegowda, Murali Thyloth
July-December 2015, 20(2):80-81
DOI:10.4103/0971-8990.174600  
Lithium is a commonly used mood stabilizer. However, because lithium has a low therapeutic index, lithium-induced drug toxicity is frequently seen in clinical practice. While most side effects of lithium use reverse after the drug is discontinued, in rare cases patients develop a persistent neurological side effect known as a syndrome of irreversible lithium-effectuated neurotoxicity (SILENT). We report a case where the patient developed SILENT even when given a therapeutic dose of lithium. Our case also supports the biological mechanism of SILENT, which involves demyelination at multiple sites in the brain.
  3,856 178 -
REVIEW ARTICLES
New psychoactive substances: Issues and challenges
Vaibhav Patil, Abhinav Tewari, Ravindra Rao
July-December 2016, 21(2):98-104
DOI:10.4103/0971-8990.193427  
New psychoactive substances (NPS) have emerged as "legal" alternatives to internationally controlled drugs and commonly known by terms such as "designer drugs," "legal highs," or "herbal highs." These drugs are gaining popularity among youth in recent times as they are less expensive and easily available through head shops and internet. Till date, data about the extent and use of NPS in general population are limited. A large number of NPS are entering the user market due to the infinite possibility of altering the chemical structures of existing NPS to derive new substances, making them difficult to monitor. There is limited evidence of health damage associated with the use of NPS; research has also shown that some NPS have medical use also, which creates a dilemma for blanket control of all of these substances. Further, these drugs are not detected by traditional detection methods making them popular substitute for controlled substances, increasing challenges to laboratories and legal system. These issues and challenges would be important for clinicians, law enforcement authorities, and policy makers to consider for mounting an effective response to control the use of NPS.
  3,661 321 -
CASE REPORTS
A case of persistent delusional disorder: Role of dimensions of delusion reappraised
Arghya Pal, Arpit Parmar, Piyali Mandal, Rajesh Sagar
January-June 2016, 21(1):64-65
DOI:10.4103/0971-8990.182095  
The themes of delusion have been a subject of interest due to the complex underpinning of several socio-cultural aspects. Although it is defined to be out of keeping with the socio-cultural background, the interplay often poses a diagnostic dilemma. Here, we report an unusual case of persistent delusional disorder involving surgically inserted “Gas” in the background of beliefs arising from relatives, lay press, and nontraditional medicine.
  3,586 131 -
REVIEW ARTICLE
Roar of meow-meow (mephedrone) in India
Pooja Yudhishthir Palkar, Anand Ajit Kumthekar
July-December 2015, 20(2):55-58
DOI:10.4103/0971-8990.174591  
Recently, a dangerous new designer drug mephedrone has fast gained popularity among the youth and teens of India. Its abuse has soared to mount to an epidemic. It has psychoactive properties and is believed to bring about effects similar to the use of cocaine, amphetamine, and 3,4-methylenedioxy-N-methylamphetamine. The aim of this review is to discuss how mephedrone acts, health risks with its use and its emergence in India. The past and the emerging PubMed and Internet literature on mephedrone, and synthetic cathinones are reviewed. Recent studies suggest that use of synthetic cathinones lead to not just serious psychiatric but serious neurological, cardiovascular, and sexual health sequelae as well. Use of these designer drugs may lead to multi-organ failure and death. It has become increasingly evident that mephedrone is highly dangerous to public health. This warrants educating and training healthcare providers to provide optimum management.
  3,546 142 1
CASE REPORTS
A case series of five individuals with asperger syndrome and sexual criminality
Shankar Kumar, Yamini Devendran, Amrtavarshini Radhakrishna, Varsha Karanth, Chandrashekar Hongally
January-June 2017, 22(1):63-68
DOI:10.4103/0971-8990.210703  
The prevalence of autism spectrum disorders has increased in recent years and so has the focus on high functioning autism and Asperger syndrome. A subset of Asperger individuals appears to have a propensity to engage in acts of violence, particularly sexual crimes, which may best be attributed to the core features of their pathology such as “mind-blindness” and paucity of central coherence. This paper is an account on five such cases encountered in our hospital for whom various assessments were done including Mini International Neuropsychiatric Interview, intelligence quotient assessment by Binet Kamat test of intelligence, Montreal Cognitive Assessment, Ritvo Asperger's and Autism Diagnostic Scale, and Gillberg's criteria for diagnosis. These cases gained legal attention and “undeserved” outcomes. By drawing parallels from other countries, a few suggestions have been highlighted in the paper that can be considered to discard glaring deficits in the criminal law system in India in this context.
  3,436 183 1
ORIGINAL ARTICLES
A study on relationship of internet addictive behavior with personality traits among medical students
Vijay Kumar Saini, Girish Chandra Baniya, Kamal Kumar Verma, Aditya Soni, Santosh Kesharwani
July-December 2016, 21(2):108-111
DOI:10.4103/0971-8990.193429  
Context: Internet addiction is less researched entity in developing countries. There has been an explosive growth in the use of internet worldwide including India in the last decade. Aims: To study the relationship of internet addictive behavior with personality characteristics among medical students. Settings and Design: This was a cross-sectional observational study carried out on 140 medical students. Subjects and Methods: All the students were taken randomly. Assessment of sociodemographic details was done with the help of  semi-structured pro forma, and internet addiction test and big five inventory were used to assess internet addictive behavior and personality traits. Statistical Analysis Used: For comparison of dichotomous variables, Chi-square test was used. Correlation and linear regression were applied to see association. Data analysis was done with the help of  statistical software SPSS 23. 0 (Statistical Package for the Social Sciences by IBM Corporation). Results: Mean score of internet addiction scale among medical students was 33.94 (standard deviation 13.592). It was found that higher neuroticism (β =0.242, P = 0.004) and less extroversion (β = −0.210, P = 0.011) displayed significant associations with internet addictive behavior. Conclusions: Neurotic individuals tend to experience increased levels of stress and interpersonal conflict because of this personality trait. Internet addictive behavior was lower on extroversion traits because they are more in social activities, making friend easily, and cheerful.
  3,360 242 1
REVIEW ARTICLES
Late onset depression: A recent update
Ananya Mahapatra, Pawan Sharma, Sudhir Kumar Khandelwal
January-June 2015, 20(1):4-11
DOI:10.4103/0971-8990.164799  
Late onset depression has recently emerged as a serious mental health issue in the geriatric population with significant public health implications. It is often challenging to diagnose and treat this entity. Various theories have been postulated to elucidate the etiology of late onset depression, but a unifying hypothesis is lacking. Although the vascular hypothesis is most researched; a complex interaction of multiple vulnerability factors is the current focus of attention. Numerous psychosocial variables have been implicated to play a significant role in predicting the onset and severity of late-life depression. Phenomenological differences have been delineated from depression occurring at a younger age, but the findings are equivocal. A better understanding of the natural trajectory of depression in the elderly is required for early diagnosis and effective treatment. This review attempts to summarize the current status of evidence regarding epidemiology, etiology, clinical features, and treatment options available for late-onset depression.
  3,388 198 -
ORIGINAL ARTICLES
Misuse of social media marketing by alcohol companies
Zakirhusain A Shaikh, Rambha Pathak, MC Kapilashrami
January-June 2015, 20(1):22-27
DOI:10.4103/0971-8990.164805  
Background and Aims: Epidemiological transition in the form of noncommunicable diseases (NCDs) now becoming the main cause of mortality and morbidity is very much evident even in developing countries like India. Alcohol is an important risk factor for NCD. The use of alcohol is increasing especially in young people and women. This increased use can be attributed to aggressive and innovative marketing by alcohol, in spite of and due to restrictions on its marketing. Social media, in recent times, has been misused by alcohol companies for marketing their products legally, due to legal loophole. The present study examined the reach of alcohol companies on social media and the marketing strategies used by them. Design, Settings, Participants: Facebook, Twitter and YouTube were explored for accounts and content by alcohol companies for marketing their product. Policies of social media sites pertaining to alcohol marketing were also studied. Measurements: Alcohol marketing was measured in terms of content posted by alcohol companies, use of direct or surrogate advertisement and engagement with users. Findings: Alcohol companies have been conveniently using social media to target young urban population with direct and surrogate advertisements of their products. Current social media policies and laws are ineffective in controlling it. Conclusions: Amendment of laws pertaining to alcohol marketing to include social media also in its ambit is necessary. Social media sites should revise their policies to prevent alcohol marketing and promotion especially to underaged users.
  3,418 152 1
INTERNATIONAL PERSPECTIVE: REVIEW ARTICLE
Community mental health service: an experience from the East Lille, France
Jean Luc Roelandt, Nicolas Daumerie, Laurent Defromont, Aude Caria, Paula Bastow, Jugal Kishore
January-June 2014, 19(1):10-18
DOI:10.4103/0971-8990.143884  
Over the past 30 years in the Eastern Lille Public Psychiatric sector, there had been progressive development of set up in community psychiatry. This innovative set up conforms to WHO recommendations. The essential priority is to avoid resorting to traditional hospitalisation, and integrating the entire health system into the city, via a network involving all interested partners: users, carers, families and elected representatives. The ambition of this socially inclusive service is to ensure the adaptation and non-exclusion of persons requiring mental health care and to tackle stigma and discrimination. It gives a new perception to psychiatry that is innovative and experimental, and observing human rights, i.e. citizen psychiatry. This experiment also provides lesson to India for effective implementation of its national mental health program.
  3,480 81 1