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.

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Background: Over the last few decades there has been increased health related issues due to arsenic poisoning worldwide. In India, in state of Bihar, 18 districts are affected from arsenic poisoning causing various health related problems in the exposed population. Arsenic poisoning in Buxar district of Bihar in the recent times has been identified as one of arsenic hotspot of Bihar due to serious health related problems including cancer. Aims and Objectives: The present study aims to find out that whether arsenic contamination in groundwater causes impaired memory and intelligence in school children of Simri village of Buxar district of Bihar or not? Materials and Methods: In the present study, water samples were collected from three hand pumps, which were utilized by the school children for drinking purpose since last ten years. Hair samples of 65 students enrolled in this school were also collected for the analysis of arsenic concentration and its correlation with the drinking water arsenic was done. The same students were interviewed for neuro-behavioural and memory tests for which various methods were utilized like continuous performance test (CPT), symbol digit test (SDT), pattern memory test (PMT) and switching attention behavior (SAB). Results: The study revealed high arsenic concentration in the water and hair samples. The correlation between high arsenic concentration in water and hair denotes high degree of exposure. Their neuro-behavioural analysis reflected very alarming observations like impaired intelligence memory pattern along with the inattention, loss of concentration and alertness. The highest arsenic concentration in drinking water observed was 857 μg/L while in the children hair sample the maximum value was 12.609 mg/Kg. Conclusion: The present study thus concludes that arsenic poisoning is causing changes in the neuro-behavioural activities in school children of Simri village. Therefore, a specific strategy is urgently required to control the present problem.

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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.

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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.

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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.

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Background: Depression is a common yet often underdiagnosed psychiatric comorbidity in patients with chronic skin disorders. Presence of depression can be an aggravating and perpetuating factor for these conditions. Aim: To determine the frequency of depressive disorder and suicidal ideation in adult dermatology outpatients with acne, psoriasis, and alopecia areata and also to determine the correlation between severity and duration of the skin disease with the severity of depressive disorder. Materials and Methods: A total of 174 new patients attending the dermatology outdoor clinic of our hospital diagnosed with acne, psoriasis, and alopecia areata were assessed by the psychiatrist for comorbid depressive disorder and suicidal ideations using Beck Depression Inventory (BDI) and Beck Scale for Suicide Ideation, respectively. Results: Depressive disorder was found in 8.8%, 26.8%, and 13.2% of patients with acne vulgaris, psoriasis, and alopecia areata, respectively, whereas suicidal ideation was found in 1.2%, 5.4%, and 2.6% patients, respectively. Significant correlation of BDI score was found with the severity of psoriasis and alopecia areata and with the duration of alopecia areata. Conclusion: Diagnosing and treating the hidden psychiatric comorbidity in patients with dermatological illnesses can help achieve better control of dermatological disorder and provide holistic care to such patients.

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Context: As psychiatric illness requires long-term treatment, some patients are lost to follow-up. Aims: The present study aimed to find the follow-up pattern of psychiatric patients attending psychiatry outpatient department (OPD) and to determine the correlation of follow-up with socio-demographic profile and diagnosis, if any. Settings and Design: This study was a retrospective data analysis study carried out at the OPD of Psychiatry, Christian Medical College and Hospital, Ludhiana. Subjects and Methods: New cases attending the OPD from April 2010 to March 2011 were included in this study. The data were scrutinized 1 year after the initial assessment. Socio-demographic data, diagnosis and follow-up information were obtained from the files. The collected data were statistically analyzed. Statistical Analysis Used: Chi-square and P value. Results: 53.1% of the patients dropped out after first visit, 29.4% patients had 1-3 follow-up, 14.9% had 4-10 follow-ups and only 2.6% had more than 10 follow-ups. Correlation between follow-up and various socio-demographic variables such as age, gender, place of living or distance from hospital, occupation, religion and marital status was not statistically significant. It was, however, seen that cognitive disorders, conversion disorder, mental retardation, and patients in which diagnosis was deferred, had more dropout rate after first visit. Conclusions: In our study 53.1% of the patients did not attend follow-up at all and only 2.6% had more than 10 follow ups. Correlation between follow-up and various socio-demographic variables was not statistically significant. Patients in which diagnosis was deferred had more drop out rate than patients who had a diagnosis and the difference was statistically significant.

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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.

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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.

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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.

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Background and Aims: Patients with mental disorders often do not seek professional help for a multitude of reasons. These issues need to be highlighted and addressed. This cross-sectional study aims to collect and to analyze treatment-seeking behavior in psychiatric patients. Subjects and Methods: Five hundred patients presenting to psychiatry Outpatient Department of a tertiary hospital in Delhi, were recruited after obtaining written informed consent. Patients were diagnosed based on the International Classification of Disease-10 criteria, and sociodemographic details were collected. Treatment-seeking behavior schedule was applied. Results: Patients between 18 and 35 years of age constituted around 60% of the total treatment-seeking patients and only 2% were above the age of 65 years. More than 60% of the sample belonged to an urban, middle socioeconomic background from nuclear families. Depression and anxiety disorders were the most common psychiatric morbidities followed by psychotic disorders and substance use disorders. Up to half of the sample had sought treatment before coming for consultation. Of these 55% visited nonpsychiatric doctors, 30% of psychiatrists and others consulted faith healers, alternate medicine, and psychologists before visiting our facility. Easy accessibility, faith, and good reputation were the reasons for going to a doctor while belief in the supernatural causation of mental illness was the major reason for seeing a faith healer. Mostly, a family member had given information about our facility. Previous ineffective treatment and cost concerns regarding medications were the predominant reasons to visit after prior visits elsewhere. Conclusion: Factors determining treatment-seeking behavior can help address problems and delay in early identification and optimal management of mental disorders.

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Introduction: Job satisfaction and organizational stress among employees are two important key components of any successful organization. It is important to maintain a balance between the level of job satisfaction and perceived stress among nurses for rendering quality care in the health sector. Materials and Methods: A correlational study design was adopted for the study. A simple random sampling technique was used to recruit 100 staff nurses working at a tertiary care hospital. Job satisfaction scale (JSS) and the organizational role stress (ORS) scale were used to collect data related to job satisfaction and ORS among nurses. Results: Study results showed that majority (92%) of staff nurses were ambivalent regarding their job satisfaction. There was a significant negative relationship between ORS and job satisfaction (r = −0.289, P < 0. 01) among staff nurses. Discussion: The study revealed that many factors influenced job satisfaction and ORS among nurses. Nurse managers and administrators must be alert to suggest the suitable interventions timely to ensure the staff nurses satisfied and get a hassle-free working atmosphere.

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The concept of Physician Burnout emerged in the 1960s. Over the last six decades or so, it has been recognized as a worldwide phenomenon. This brief review presents the evolution of the concept, risk factors, epidemiology, clinical manifestations, assessment, prevention, and management of physician burnout. Available data suggest that different theoretical models have been proposed and evaluated to understand the emergence of burnout at the workplace. The risk factors for the development of burnout can be understood as personal and organizational factors and interaction of these factors, determine the final experience of burnout. The incidence of burnout among medical professionals is generally reported to be higher than other professionals, and high rates of burnout are seen across all the stages of medical career, i.e., medical students, interns, postgraduates, and practicing physicians. There are some data to suggest rising trend in the prevalence of burnout among physicians. The common signs and symptoms of burnout include anger, irritability, impatience, increased absenteeism, decreased productivity, and decreased quality of care. However, many authors have categorized the symptoms into different stage models. Burnout among physicians is associated with multitude of negative consequences for the physicians, and patients, and the health-care system. Available data suggest that it is important to recognize burnout at the earliest and use preventive strategies for emergence of the same. At present, there are no clear-cut guidelines for the management of burnout, but some of the individual-level interventions, which are thought to be helpful for burnout, include cognitive-behavioral techniques, meditation and relaxation techniques, development of interpersonal skills, and development of knowledge and work-related skills. In addition to this, various interventions carried out at the level of organization and the physician–organization interface have also been proposed to address physician burnout.

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Background: There are no studies on pathways to psychiatric care in patients seeking help at private psychiatric hospitals in India. Aim: This study aims to study help-seeking behavior and pathways to care among patients-seeking treatment at a private psychiatric hospital in North India. Subjects and Methods: Fifty newly registered patients were assessed for their help-seeking behavior and pathways to care before seeking the current consultation. Descriptive analysis was performed. Results: Most of the patients sought help either as self-referral or on advice of their relatives, friends, and other patients. Eighty percent of patients had seen a care provider within 1 month of onset of their symptoms. Forty-eight percent patients approached a psychiatrist while 34% approached a faith healer or unqualified local practitioner as their first care provider. Conclusion: Patients with mental illnesses vary in their help-seeking behavior with regard to their choice of first care provider, time to reach a psychiatrist, and number of care providers sought for their mental health problems.

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Self-mutilation is not a single clinical entity and occurs in various psychiatric syndromes. Major self-mutilation is rare and catastrophic complication of severe mental illness. Patients with command hallucinations, religious preoccupations, substance abuse and social isolation are the most vulnerable. We report and discuss a case of complete self-mutilation of nose in a patient with schizophrenia.

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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.

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Background and Aim: Metabolic syndrome (MS) is found to be more prevalent in patients with depression. As there is a lack of Indian data, this study was aimed to assess the prevalence of MS and its association with liver enzymes and C-reactive protein (CRP) in drug-naive patients with depressive disorders. Methods: Prevalence of MS was assessed in 170 patients with depressive disorders and thirty healthy controls using Modified National Cholesterol Education Program Adult Treatment Panel-III criteria. Liver enzymes and CRP were also assessed for patient group. Results: MS prevalence was 25.9% in patients with depression, which was higher than the healthy controls (17.3%). Lower HDL level was the most common abnormality in depression group. Compared to healthy controls, significantly greater proportion of patients with depression had abnormal fasting blood sugar and HDL levels. Besides MS, another 61% fulfilled one or two criteria of MS. Significant predictors of MS were age, duration of psychiatric illness, body mass index, obesity, gamma-glutamyl transferase (GGT), and CRP levels. Conclusions: One-fourth of the depressed patients had MS and another three-fifth of the patients had one or two metabolic abnormalities, and these were associated with greater GGT and CRP levels. Patients with depression should be regularly evaluated and timely treated for cardiovascular risk factors.

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Background: There has been extensive research on the stigma experienced by patients with psychiatric disorders and their family members. However, very few studies have attempted to compare both the perspectives. Aim: To measure and compare the stigma experienced by patients with psychiatric disorders and their caregivers. Materials and Methods: A total of 143 patients suffering from various psychiatric disorders (including substance use disorders) who visited at the psychiatry out-patient clinic were included, along with their family members. In addition to the sociodemographic and clinical variables, they were assessed using a stigma scale (Hindi version). Results: Patients with psychiatric disorders scored significantly higher than their caregivers on the total stigma scale score as well as on the subscales for discrimination, disclosure and positive aspects. Patients with substance dependence as well as their caregivers had highest total stigma score. The mean difference among the patients and caregivers was highest among the obsessive compulsive disorder subgroup (P = 0.012) and lowest among the schizophrenia subgroup (P = 0.045). Conclusion: Stigma and discrimination are deeply rooted among patients and their caregivers. Tackling stigma and discrimination should form an integral part of the therapeutic process.

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Context: Previous studies have reported high psychiatric comorbidity with physical illness. However, referral rate to consultation-liaison (C-L) psychiatry from other departments is very low. There is a paucity of literature from India in this subspecialty of psychiatry. Aims: This study was conducted to assess the sociodemographic profile and psychiatric diagnosis of patients referred to C-L psychiatric services at a tertiary care center. Settings and Design: This was a descriptive cross-sectional study conducted in a tertiary care multispecialty teaching institution. Patients and Methods: The study population comprised all the patients who were referred for psychiatric consultation from other departments to C-L services of psychiatry department for 2 months. Information was collected using semi-structured pro forma, and diagnosis was made based on the International Classification of Diseases-10 criteria. Results: A total of 160 patients were referred for C-L psychiatric services. Majority of the patients were in the age group of 31–45 years, married, educated matriculation or beyond, belonged to Hindu religion, nuclear family, and residing in urban area. The maximum referrals were from internal medicine department (17.5) followed by nephrology (15.0%) and neurology (10.6%). The most common psychiatric diagnosis was depression (12%) followed by delirium (8%). The most common reason for seeking psychiatric consultation was psychiatric clearance of prospective kidney donor and bone marrow transplant/stem cell transplant recipient. Conclusions: Psychiatric comorbidity may present with chronic physical illness. The C-L psychiatry would play a major role in the management of psychiatric comorbidity.

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Context: Reduced behavioural inhibition, characterized by impulsivity and disruptive behaviour disorders, has been identified as a developmental precursor of alcoholism with a considerable genetic component. Aims: The present study aimed to assess whether children of fathers with alcohol dependence have high impulsivity and externalizing behaviours. Setting and Design: Observational case-control study, done in a tertiary care teaching hospital of Southern India. Materials and Methods: The present case-control study recruited 50 children aged 7 to 14 years of fathers with alcohol dependence and 50 age- and gender-matched children of fathers without alcohol dependence. The two groups were compared using the DSM-IV-TR criteria for ADHD, the Barratt Impulsivity Scale (BIS) and the Child Behaviour Checklist (CBCL). Statistical Analysis Used: Descriptive statistics used to summarise the study findings. Cases and controls were compared on BIS and CBCL scores using a general linear model (GLM). All analyses were two tailed and test P value <0.05 was considered significant. Results: The children of fathers with alcohol dependence were more likely to meet criteria for ADHD (30% versus 10%, χ² = 6.250, P = 0.012). After controlling for age and gender, impulsivity scores on the BIS tended to be higher in the cases (F = 2.410, P = 0.055) than controls, mainly in the non-planning domains (F = 3.650, P = 0.008). Similarly, externalizing behaviours on CBCL were more common in the cases than controls (F = 2.817, P = 0.029). Conclusions: Children of fathers with alcohol dependence had greater impulsivity and externalizing behaviours. This may represent a behavioural phenotype as well as a potential target for early intervention.

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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.

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