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.

Understanding factors affecting the risky injection practices among people who inject drugs (PWIDs) are critical toward identifying the transition from initial injecting to HIV seropositivity. Increasingly HIV prevention programs have been focusing on targeted interventions in such high-risk groups, which include addressing some of these factors. We reviewed the literature on factors associated with HIV-related high-risk injection behavior among PWIDs using electronic databases such as Pubmed and Google scholar. This was supplemented by manual search for non-indexed and grey literature. The factors studied include age and age of initiation, duration of use, concurrent alcohol use, social networks, stigma, and impact of the intervention. In general, there is a lack of studies from developing countries, and most of the literature are from western settings. Across studies, the risky injection practices have been consistently associated with early age of initiation and social network characteristics such as family member using injections, using injections with the sexual partner. However, studies have shown inconsistent association with current age, duration, and exposure to interventions for substance use disorders. Despite strong theoretical underpinning of a positive association, there is inadequate literature on factors such as alcohol abuse and stigma. This narrative review highlights the need for high-quality studies addressing factors associated with HIV-related high-risk injection behavior.

Background: Attempted suicide is one of the major emergencies in psychiatry. Suicide attempts are considered to be the best predictors of an eventual completed suicide. Data of patients presenting with attempted suicide to the emergency settings at mental health institute settings is scanty in India. Aims: The study was carried out to assess the socio-demographic and clinical profile of the patients with suicidal attempt attending emergency services at a teaching Mental Health Institute in Northern India. Methods: Case records of all patients with attempted suicide attending emergency services at Institute of Human Behaviour and Allied Sciences (IHBAS) for one calendar year were reviewed. Socio-demographic and clinical details of the patients were retrieved on a Performa specifically designed for this study. Results: Of all the patients who attended emergency services during the study period, 56 patients had suicidal attempts. Majority of them were married (66%), males (57%), in the age group of 20-40 years (61%), were from nuclear families (80.4%) and had urban domicile (83.9%). Severe Mental Illnesses were found in about 70% of the cases with duration of illness more than 24 months in 39.2%. Thirty six (64.3%) patients had 1 suicide attempt while 18 (32.3%) had 2 or more attempts in preceding one month. In 70% - 80% of the cases, the lethality and intentionality of the index episode was found to be moderate to high. Most of the cases needed inpatient treatment. Conclusion: Assessment and management of patients presenting to emergency room with suicidal behavior is a key factor in preventing suicide. There is a pressing need to identify the socio-demographic and clinical factors affecting risk of suicide in a given case. Every case presenting with suicidal ideations or attempt should be evaluated in detail.

Background: Depression may result in unfavorable health outcomes as it has been associated with cardiovascular morbidity. Recent researches have suggested the role of inflammation in the pathophysiology of depression and co-morbidities associated with it although the underlying mechanism relating the two is still unclear. Aim: The present study aimed to explore the association between depression and inflammatory markers including interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) and high sensitive c-reactive protein (hsCRP). Materials and Methods: Thirty drug-naοve patients of depression diagnosed on the basis of ICD-10 criteria, in the age group of 20-45 years were included in the study. They were compared with 30 age, gender, body mass index, socio-economic and educational status matched apparently healthy controls. The blood samples were taken after an overnight fast and serum samples were immediately stored until the time of analysis. Results: The serum levels of hsCRP were significantly higher (P = 0.042) in depression group as compared to the control group. Although the mean serum levels of IL-6 and TNF-α were higher in patients of depression, they were not statistically significant (IL-6: P = 0.055, TNF-α: P = 0.053). Conclusion: It can be inferred from our study that depression is associated with underlying low-grade inflammation, which might contribute to increased morbidity in patients of depression.

Background: Studies have shown that in obsessive-compulsive disorder (OCD), there is impairment of neurocognitive functioning during the symptomatic phase. However, studies that explore the "state or trait" dependent nature of these neurocognitive deficits are largely lacking. By comparing the neuropsychological functions of the clinical and subclinical group of OCD patients and healthy controls; we tried to establish whether neuropsychological deficits in OCD were "state" dependent or independent. Materials and Methods: Twenty "mild to moderate" OCD patients, 15 subclinical (remitted) OCD patients, and 20 matched healthy controls were compared and assessed on computerized battery of neuropsychological tests including Wisconsin card sorting test, continuous performance test, and spatial working memory test. The observations were statistically analyzed. Results: Executive functions in both the subclinical and clinical groups performed poorly when compared to healthy controls. The patient groups made significantly more wrong responses, more missed responses and took more time to respond. On the test of spatial working memory, the mild to moderate OCD patients showed significant impairment, but not the subclinical patients group. Conclusion: Thus, we conclude that cognitive dysfunctions are core and enduring deficits of OCD, they seem to continue into the subclinical- well state. Certain cognitive deficits, depending on their presence or absence in subclinical cases, may be identified as "state" or "trait" markers of OCD.

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.

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.

Psychosis in Parkinson's disease (PD) is a frequently documented clinical phenomenon, whicj poses several clinical and management issues. The antagonistic nature of medications makes the treatment more challenging. The advanced age and medical co morbidities call for a more cautious monitoring. The goal should be to make the patient optimally functional as far as motor and psychotic symptoms are concerned. The case discussed here demonstrates a case of psychosis occurring in the context of PD, and highlights the complex issues involved in the management, and discuss them in light of recent research.

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.