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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The concept of "Tarasoff duty" is familiar to mental health professionals. Entwined with the name of Tarasoff, is that of Prosenjit Poddar, the other important character in the story which led to the courts giving directions for mental health professionals with regard to their duty of warn. Prosenjit Poddar killed Tatiana Tarasoff when his advances toward her were rebuffed. However, the court ruled that the mental health professional who was treating Poddar and was in knowledge of his intentions to harm Tarasoff, did not take adequate measures to warn the potential victim. This led to courts laying statutes for warning the potential victims by mental health professionals when their clients disclose such threats. However, the ruling has been a matter of debate about when to take any threat seriously and how to tread cautiously given the therapist-client privilege. The case of Prosenjit Poddar throws light on complex issues related to balancing confidentiality and potential harm to others.

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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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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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Temporal lobe pathologies have often been associated with psychiatric symptoms. Left temporal lobe pathologies usually present with localizing neurological signs, however, right temporal lobe pathologies often go undetected. Here, we describe a case with unique psychopathology in form of musical hallucinations as the only silent manifestation of underlying right temporal lobe stroke. Case presentation, inherent diagnostic dilemma, and innovative treatment methodology have been described.

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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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Objectives: The objective of this study is to determine the prevalence and sociodemographic correlates for mental illness among inmates at Mukobeko Maximum Security Prison, Zambia. Materials and Methods: A cross sectional study was conducted to assess psychiatric disturbance using a Self-Reported Questionnaire (SRQ20). A cut off point of 7/8 was used. The Chi-square test and Fishers' exact test were used to determine associations at the 5% significance level, and magnitude of association was estimated using the odds ratio and its 95% confidence interval. Results: Of the 394 inmates in prison, 29.2% had a current mental illness. Gender status was significantly associated with mental illness. Male participants were 35% (odds ratio = 0.65, 95% confidence interval [0.51, 0.82]) less likely to have mental illness compared to female participants. Conclusions: The prevalence of mental illness is high in Mukobeko Maximum Security Prison in Zambia. Gender-specific interventions should be designed to reduce the level of mental illness in this prison.

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There are increasing number of deep vein thrombosis (DVT) cases that are associated with the use of atypical antipsychotics. We are presenting a case report of a female patient who suffered from DVT. She was a known case of schizophrenia and was on risperidone 4 mg for the last 5 years. She had good physical health before that and there were no known risk factors for DVT. The family history of DVT was also found to be negative. She was managed by intravenous heparin followed by oral warfarin and amisulpride 100 mg/day. Atypical antipsychotics can induce DVT, and psychiatrist should be careful about it.

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Background: The comorbidity of substance abuse and mental disorder is known to exist and may cause many diagnostic, prognostic, and management difficulties. Indian data are sparse in this area. Objectives: The aim of the study was to identify the prevalence and pattern of substance abuse in psychiatric outpatients and to examine the relation between demographic variables and drug abuse pattern. Materials and Methods: Medical records of the patients attending psychiatry outpatient clinic at a tertiary care general hospital over a 3-month period were reviewed. Information was obtained from medical chart and Drug Abuse Monitoring Scale pro forma about substance abuse. Psychiatric diagnosis made by a qualified psychiatrist according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition diagnostic criteria, as recorded in the case record form, was used. Observation: The results revealed that 50.8% (half) of all psychiatry outpatients were using one or more substances including tobacco in the last month prior to registration (1 month prevalence) and 28.35% were using substances at any time in their life prior to the last month (lifetime prevalence). Male patients had 6 to 8 times higher substance abuse than female patients. Tobacco and alcohol were found to be the most common substances of abuse, followed by cannabis. Part-time and full-time employed male patients consumed more alcohol and tobacco than unemployed patients. Conclusions: Substance abuse was common among mentally ill outpatients and could be the cause of various health hazards and hence requires due attention.

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Childhood substance abuse and delinquency often progress to harder substances and antisocial personality disorder and carries deleterious consequences for self, family and community at large. Early management of such cases poses several clinical and management challenges, as highlighted in the present case. The treatment seeking for this sub-population is very low in spite of community surveys showing a worrisome pattern of substance use among younger population. Further, very few specialty clinics and trained manpower exist in the country to manage early onset substance use. Whether conduct disorder be cause or consequence for drug use is debatable, in view of shared risk factors. The present case helps to understand need for comprehensive assessment for identifying risk factors and comorbid conditions. Only pharmacological management does not help, psychosocial management must be delivered. Several prevention strategies may also help if these risk factors are identified before progression to illicit substance use disorder.

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Background: Disengagement of patients from psychiatric care is a known and a serious issue worldwide. However, very limited data are available on dropout of adolescent patients with mental health disorders. Aim: This study was planned to look into the profile and diagnosis of adolescents with single visit to psychiatry outpatient department (OPD). Materials and Methods: A retrospective chart review of cases in the age group of 12-18 years reporting to Psychiatry OPD of a tertiary care hospital of India was carried out. Diagnosis and profile of those who came only once were noted and analyzed for the present study. Results: From 2008 to 2011, a total of 2006 adolescents were registered which included 560 cases with mental retardation, epilepsy, and nil psychiatry. From the remaining 1446 adolescents, 659 (45.57%) did not come after the first visit. The rate of dropout at the single visit was significantly higher in females and in the age group of 16-18 years. It was highest in those with borderline intelligence, adjustment disorders, anxiety disorders, dissociative and somatoform disorders, and substance use disorders.  Conclusions: There is huge dropout rate at single visit itself in adolescents. Adolescents do not present themselves to psychiatric services in India. Parental understanding of mental disorders needs to be improved to prevent early dropout.

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