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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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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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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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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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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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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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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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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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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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: 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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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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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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Context: Number of scientific personnel traveling to Antarctica for short summer stay far outnumbers winter personnel. Hence, psychological issues confronting such personnel need to be analyzed in detail. This study aims to study changes in psychological health, cognitive functioning, changes in motivation levels, and tobacco and alcohol consumption during a summer in Antarctica. Aims: To study changes in psychological health, cognitive functioning, changes in motivation levels and tobacco and alcohol consumption during a summer in Antarctica. Setting and Design: This cohort study was conducted on 33 summer team members of 27 ^th Indian Scientific Expedition to Antarctica. Subjects and Methods: Seven instruments were administered to assess general health, alcohol and tobacco dependence, memory and cognitive functioning of the team members. Statistical Analysis Used: The data were analyzed for statistical significance using nonparametric Wilcoxon Signed Rank Sum Test. Results: Scores on social dysfunction, depression, and somatic symptoms increased. Tobacco consumption also increased concomitantly. However, memory and cognitive function were not impaired. Alcohol consumption did not change. None of the subjects needed medication or evacuation for psychological difficulties. Conclusion: Psychological issues might manifest themselves even during a short stay in Antarctica during the summer season.

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Objectives: This study aimed to evaluate the prescription pattern of inpatients admitted in the psychiatric unit of a tertiary care hospital at the time of discharge from the inpatient setting. Material and Methods: In this retrospective chart review data of 496 patients admitted in the psychiatric unit of a tertiary care hospital in northern India diagnosed with an International Classification of Diseases-10 diagnosis of psychotic, affective and neurotic disorder were extracted and analyzed. Results: In all diagnostic groups, olanzapine was the most commonly prescribed antipsychotic followed by risperidone. Very few patients (8.8%) received typical antipsychotics. Venlafaxine was the most commonly prescribed antidepressant; other frequently prescribed antidepressants were fluoxetine, amitriptyline, and sertraline. Among the mood stabilizers, prescription of valproate exceeded that of lithium. In all the groups, more than half of the patients were prescribed benzodiazepines, clonazepam being the most commonly prescribed agent, followed by lorazepam. The mean numbers of psychotropic medications were highest in the bipolar disorder group. Very few patients received the combination of drugs belonging to the same class i.e.,, receiving two antidepressants or two antipsychotics. Conclusion: Olanzapine, venlafaxine, valproate and clonazepam are the most commonly prescribed antipsychotic, antidepressants, mood stabilizers and benzodiazepines, respectively.

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Background and Aim: Available literature is inconsistent for the role of Vitamin D supplementation in depression. With scarcity of Indian data, we aimed to study Vitamin D deficiency in patients with depression, its association with time to remission and role of Vitamin D supplementation. Methods: A total of 158 outpatients with depressive disorders were consecutively assessed for Vitamin D deficiency, severity of depression, physical activity, and nutritional habits and followed-up for 1 year. Eighty-seven patients completed follow-up for 1 year (55% retention). Results: Mean serum Vitamin D level was 11.9 ng/ml and the majority of patients (85%) had Vitamin D deficiency (<20 ng/mL). Significant predictors of hypovitaminosis D were being female, unemployed or homemaker, from nuclear family and with a smaller height. Vitamin D deficient patients took significantly longer time in remission than nondeficient patients (2.86 months vs. 1.35 months, P= 0.006). Patients with Vitamin D deficiency received Vitamin D supplementation and subsequently their time to remission was comparable to nondeficient group. Conclusions: The majority of patients had Vitamin D deficiency, took a longer time to remission and reported improvement with Vitamin D supplementation. It signifies the importance of treating hypovitaminosis D for effective management of depression, to avoid delay in response, and incomplete remission.

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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.

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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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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.

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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.

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