Aim: Psychiatric morbidities seem to be one of the biggest hurdles in the stigmatized people of transgender. Lack of knowledge and ignorance with ever-growing abuse over this population make them vulnerable for mental instability. This study is an attempt to identify and access the psychiatric morbidities of gender dysphoric people of Imphal, Manipur. Materials and Methods: Using DSM-5 all qualified, consenting gender dysphoric people were assessed for psychiatric morbidities using Mini-International Neuropsychiatry Interview-Plus scale at Imphal, Manipur, and the results were compared using Chi-square test. Results: Substance use disorders were found in the majority of them. Twenty (62.5%) of them had current alcohol abuse, and 10 (31.2%) of them were dependent of alcohol. Fifteen (46.8%) of them were abusing other nonalcoholic psychotropic drugs. Twelve (37.5%) were suffering from generalized anxiety disorder (GAD) followed by 10 (31.2%) with current depressive disorder. Past suicidal attempts were found among 10 (31.2%) of them with 14 (41.2%) out of them for having current suicidal risk. Six (18.7%) of them were having dysthymia, 2 (6.2%) had panic disorder, 3 (9.4%) had agoraphobia and posttraumatic stress disorder, respectively, 8 (25%) suffered from social phobia, and 1 (3.2%) from specific phobia for spiders. Conclusions: This study found high prevalence of comorbid psychiatric disorders of which alcohol use disorder was the prominent one. Other psychiatric disorders such as GAD, depression, and suicidal risk were also found to be higher among these people. As this population is at higher risk of developing other psychiatric problems, regular screening and timely intervention is needed to prevent or treat psychiatric comorbidities.

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Context: The number of elderly patients is expected to rise. However, the efforts required to integrate this aging population into our health-care system seem to be lacking. An improvement definitely has to be aimed for because the subject of geriatric medicine will personally concern each one of us in the future. Aims: This study aims to assess and compare knowledge, attitude, and perception toward elderly and aging in medical interns and postgraduate residents and compare attitudes toward aging among the different postgraduate branches. Settings and Design: This study was conducted at a tertiary care teaching municipal hospital and medical college. This was a cross-sectional study utilizing self-constructed structured questionnaires. Materials and Methods: Questionnaires on knowledge, attitude, and perception, constructed by the lead researcher and reviewed by an expert panel, were administered to the two groups. The responses were collected and analyzed. Statistical Analysis Used: Chi-square test and means of percentages were used. Results: Both groups showed a positive perception to the needs of the elderly. The interns showed a more negative attitude toward aging compared to the postgraduate students, with the differences being significant (P < 0.05) between the two groups in 16 out of 45 questions. On the knowledge questionnaire, a significant (P = 0.014) difference was seen between the teaching in interns and postgraduates. The analysis also revealed that general medicine and psychiatry had the best scores on the attitude questionnaire. Conclusions: Although the perception of elder-friendly city is same in both groups, interns have a more negative attitude toward aging which could stem from the inadequate knowledge being imparted during the undergraduate medical curriculum. Hence, there is a need to introduce geriatric medicine at an undergraduate level.

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Background: Occupational stress is common in nurses. Stress can impact the health of the nurses leading to somatic complaints. Aims and Objectives: (1) To determine the extent and causes of occupational stress among nurses at Bhabha Atomic Research Centre Hospital. (2) To compare the stress levels among nurses depending on their years of experience. (3) To study any correlation between stress levels and the extent of somatic complaints. Materials and Methods: Ninety-seven staff nurses without any preexisting psychiatric illness were evaluated for occupational stress using the Expanded Nursing Stress Scale. The extent of somatization was measured using the Patient Health Questionnaire – 15, in a cross-sectional study. Cronbach's alpha, analysis of variance, and Spearman's correlation co-efficient test were applied to the data. Results: An internal consistency of 0.945 was noted using Cronbach's alpha. 51.5% nurses experienced mild, 34% experienced moderate, and 2.10% experienced severe stress. Conflicts with supervisors, patients, and their families and workload were the main causes of occupational stress while discrimination was the least affected domain. Nurses with 6–10 years of experience had maximum stress. The stress levels correlated with the extent of somatic complaints. Conclusions: Occupational stress is prevalent in nurses. It may be higher in nurses with lesser experience and it can be associated with somatic complaints.

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The relationship between testosterone and psychiatric disorders has been a long-standing one. The sex difference in schizophrenia has triggered to better understand the role that testosterone plays in the unfolding and clinical presentation of this psychotic disorder. DHEA and testosterone are found to influence dopaminergic, glutamatergic and GABAergic neurotransmission systems that are believed to play a role in the pathophysiology of schizophrenia. The onset of schizophrenia in males, most frequently encountered during adolescence, is also characterized by an increase in testosterone levels. Some studies have also observed lower testosterone levels in adult males with schizophrenia (or psychosis) compared to healthy controls.

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Fluvoxamine is one of the commonly used selective serotonin reuptake inhibitors (SSRIs) as a first-line treatment for obsessive-compulsive disorder (OCD). Galactorrhea is a rarely observed adverse effect of SSRIs occurring through complex interactions between serotonergic and dopaminergic systems of brain. We report a case of fluvoxamine-induced reversible euprolactinemic galactorrhea in a 39-year-old woman after initiation of fluvoxamine for OCD. The patient's galactorrhea resolved on discontinuation of fluvoxamine.

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Context: Schizophrenia affects 1%–1.5% of the population of the world. The illness commonly affects young population disturbing and disrupting the patient as well as his family. Research has demonstrated increased physical and mental health morbidities among these caretakers. Aims: The aim of this study was to explore various stresses and social problems faced by caretakers due to patient's schizophrenia. Settings and Design: A qualitative study of the distress experienced by primary caretaker of schizophrenia patients was undertaken at a tertiary hospital in an urban Indian setting. Methods: Relatives of 30 patients were assessed for their physical, psychological, and social problems. Their narratives of distress caused by patients' illness were recorded as verbatim and analyzed qualitatively manually. Statistical Analysis: Manual qualitative and quantitative analysis. Results: Caretaker was a parent in 72.3% of the cases. Distress due to blaming by relatives for not bringing up the child carefully was reportedly experienced by most parents, especially the mothers. Local cultural setting plays a huge influence in these highly personal and sensitive concerns. Social stigma, anxiety about illness, anger, and resentment were commonly reported. Conclusions: These insights into suffering of the caretakers of people suffering from schizophrenia in current local setting need to be considered and addressed as essential part of the management of Schizophrenia.

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We present a case of a 56-year-old male who developed Capgras syndrome following hyponatremia consequent to dehydration. He was a previously healthy male who eventually developed secondary systematized delusions due to misidentification syndrome. This case highlights the need for evaluating the role of toxic/medical etiology in the causation of this syndrome that is more often encountered in schizophrenia.

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Background: The risk of lead exposure for mental illness and its burden on Indian children, as a society, is not studied till date. This study aims to present the same as well as to compare the risk and burden between 1990 and 2015. Materials and Methods: Using India-specific, Global Burden of Disease 2015 data health metrics-disability-adjusted life years (DALYs), we estimated the burden of mental illness and exposure to lead as a risk factor for the same. Descriptive estimates of prevalence and DALY for mental illness and risk of lead exposure are presented for various age groups of Indian children (0–14 years) of either gender. Results: In 2015, 26,450,345 Indian children were affected with mental illness contributing to DALYs of 2,453,344. In 2015, 162,492.1 DALYs were lost to mental illness due to risk factors and 130,429 lost DALYs due to risk attributed to lead exposure. The risk rate attribution and the difference of burden in 1990–2015 are presented. Years of life lost due to lead exposure for mental illness is high as compared to all attributed risks. Lead was identified as risk factor for intellectual disability among children. Conclusions: Lead continues to pose a significant overall health risk and specifically for mental illness. The estimated burden of mental illness and extent of association of risk indicate the urgent need of clear policies to reduce lead from our immediate environment.

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Background: Postpartum depression (PPD) is a depressive disorder, also known as postnatal depression. Despite responsiveness to treatment and serious consequences if untreated, PPD often remains unrecognized. This study aims to study the prevalence of PPD and to correlate risk factors associated with it. Materials and Methods: It was a cross-sectional study in Departments of OBGY, Pediatrics, and Psychiatry in a tertiary care hospital. Two hundred and fifty consecutive women, 1–6 weeks postpartum attending the above departments, were included after written informed consent. A specially designed semi-structured pro forma was used for correlation of various risk factors. Edinburgh Postnatal Depression Scale was used for diagnosing PPD. Results: In our study, we found that 20.4% of the women evaluated suffered from PPD. Significant risk factors for PPD included age below 30 years, financial dependence, positive family history of psychiatric illness and PPD, previous girl child, unwanted pregnancy, pressure to have a male child, and complications during pregnancy and delivery. Domestic violence, substance abuse in husband, and relationship issues also increased the risk. Conclusion: Considerable prevalence of PPD is found across various cultures. Prevention of risk factors is useful in primary prevention of PPD. In the future, our study can be used for screening females with high risk for developing PPD so that more intense interventions can be applied.

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Context: Attitudes of paramedical and medical professionals to psychiatric illnesses are important for referral and use of mental health facilities by general people. Knowledge of psychiatric disorders and experience of working with psychiatric patients may be responsible for positive attitudes. Aims: The aim was to assess attitude toward different mental illnesses among different paramedical professionals and to know the impact of education and work experience on attitudes toward mental illnesses. Subjects and Methods: Study sample was nursing staff, nursing students, and junior doctors from tertiary care hospital and students of clinical psychology from a private deaddiction center. The study design was cross-sectional. Attitude to Mental Illness Questionnaire was used with modifications and addition of demographic details. Experience of working with psychiatric patients and attending mental health primary care (MHPC) program also were included for the evaluation of attitudes. Results: Attitudes toward drug abuse, depression, alcohol abuse, and schizophrenia were more negative while toward anxiety spectrum disorders, conversion, and dissociative disorders were more positive. Subjects with experience of working with psychiatric patients and experience of MHPC program showed more positive attitudes. Conclusions: There is need of, developing program containing knowledge of mental health, implementing practical experience of working with psychiatric patients in the curriculum of paramedical and medical profession and restructuring present curriculum to develop positive attitudes to mental illnesses for benefit of community.

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Context: This hospital-based study attempts to explore the morbidity load of categorized mental disorders along with the pattern of substance use in the adolescent group of people presenting to a tertiary hospital of Manipur, India. Aims: This study aims to document sociodemographic profiles, psychiatric morbidity, and substance use pattern among the adolescents attending the Department of Psychiatry of a tertiary hospital of Manipur, India. Settings and Design: This study was a cross-sectional, hospital-based study. Subjects and Methods: This cross-sectional study included 474 consecutive adolescent patients (10–19 years) attending both outpatient department and inpatient department of the Department of Psychiatry of a Tertiary Hospital of Manipur, India, were enrolled during the study. Diagnoses were made according to the ICD-10. Statistical Analysis: The statistical software, namely SPSS 22.0 and R environment ver. 3.2.2 were used for the analysis of the data. Results: Almost 68.4% were within 16–19 years, 51.3% lived with their families, 56.1% were male, 62% of them were Hindus, and majority of them were from urban background (54.4%). Neurotic, stress-related, and somatoform disorders were the highest (41.4%), followed by psychotropic substance use in 21.3%, mood disorders in 14.8%, schizophrenia and delusional disorder in 12.2%, behavioral and emotional disorder in 9.3%, and disorders of adult personality and behavior (F60-69) in 0.4%. The most common categorical psychiatric diagnosis in males due to psychotropic substance use (37.2%) while neurotic, stress-related, and somatoform disorders (61.1%) were the most common categorical diagnosis in females. Conclusions: Very few studies have been conducted to reflect the scenario and pattern of psychiatric morbidities in the state of Manipur. We hope this study will be helpful in reflecting the psychiatric morbidity load in the adolescent group for helping them with early diagnosis and intervention.

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Introduction: Chronic kidney disease (CKD) is a global health problem with a high economic burden on the health-care system. Considering the chronic nature of disease patients undergoing hemodialysis are at risk of developing psychiatric disorders. In this study, we aimed to evaluate the incidence of depression and anxiety in CKD patients undergoing hemodialysis. Methods: This was a prospective, cross-sectional, observational study conducted between June 2016 and September 2017. Patients of either sex having CKD and undergoing hemodialysis were included in the study. Sociodemographic and depression and anxiety related details were collected. Results: A total 150 patients were enrolled in this study, of which 92 (61.3%) patients had depression and 42 (28%) had anxiety. Overall, depression was higher in males, but the difference was not significant; similarly, the anxiety was higher in males, but the difference was statistically significant (P = 0.050). Majority of patients with depression were aged more than 80 years; however, anxiety was more common in patients aged between 40 and 60 years. A total of 59.4% of depressive patients were Hindus, and 27.3% of anxiety patients were Hindus. The correlation between depression and marriage was significant; however, the relationship was not significant between anxiety and marriage. Among patients with depression 55.9% of patients were illiterate, and among patients with anxiety, 25.4% were illiterate. Conclusions: This study provides extensive information on the relationship between depression or anxiety and sociodemographics features among patients with CKD undergoing hemodialysis.

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Delirium is a common cause of disturbed behavior in medically ill people and is often undetected and poorly managed. It is a condition at the interface of medicine and psychiatry that is all too often owned by neither. Despite its clinical importance, delirium is often not detected, or is misdiagnosed as or other psychiatric illness.Hence, identification of risk factors, education of professional carers, and a systematic approach to management can improve the outcome of the syndrome. This article is for psychiatry postgraduate students to understand various aspects of delirium, bedside assessment with management of the patient with a focus on etiology , predisposing factors ,pathogenesis & different types of presentation in clinical practice.

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New psychoactive substances (NPSs) are growing at an alarming rate causing a threat to the public health. They are available online or in head shops and come with variety of street names across the cities, states, and countries. NPSs are prepared in the laboratories either by tweaking or altering the chemical structure of existing substances such as cannabis and ecstasy. They are cheap, easy to obtain, and difficult to be detected by traditional drug screening methods. It has become very challenging to detect them within the clinical settings because of the fast rate of their availability and their constant changing structure. Their purity as well as pharmacology and toxic effects are still not known. These drugs cause major life-threatening complications, which is worrisome. The legal status of these drugs is ambiguous. The laws are complex, changing, are not well defined to control or regulate their use which is a major setback. As many clinicians are unaware of the existence of such drugs, the identification and management of withdrawal syndrome and overdose become difficult. There is a need to create awareness regarding the risks and the health hazards caused by these novel substances as well as to develop and design new prevention approaches that are able to attract the attention of the young population.

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Office-based psychotherapy practice is a challenging and vexing task for psychiatrists. Psychotherapy has not yet found a firm footing as an accepted form of therapy by many patients. Psychiatrists offering psychotherapy as a treatment face many challenges that may be social, psychological, and ethical. The present review paper posits an overview of the various challenges that besiege office-based psychotherapy in private psychiatric practice. Issues right from the initiation and basic premise of describing psychotherapy and issues concerning its mechanism of action and efficacy along with individualization of therapy are discussed. The challenges of online psychotherapy and dealing with clients that refuse medical help along with the perils of eclectic psychotherapy are highlighted. Handling adolescents which poses many challenges is also discussed along with an emphasis on the sound termination of psychotherapy. The paper aims to sensitize the readers to the various challenges that office-based psychotherapy poses while providing an overview on the subject. Each of the challenges in this paper is subtopics in themselves and may warrant separate review papers in their own right.

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Indian subcontinent, diverse though in many respects, has a common systematized cultural mechanism to cope with loss. What is unique about Hindus is their belief in reincarnation and the concept of karma. Writing Living Will (LW) or the Advanced Directive, I thought, was a brilliant idea to guide families to deal with the end-of-life situation of their loved ones. I enthusiastically advised my elderly colleagues in various forums to write the LW, lest had I predicted any negative fallout of this deed. I describe below the heated debates due to LW within the bereaved families. In both cases, the families argued that the reincarnation and transmigration of the soul cycle would be interrupted by not cremating the dead. Some instructions left in the LW were at variance with the traditional practices that created potentially explosive situations in the cases I describe below. Most contentious directive was no cremation and postdeath rites and rituals that created conflict of ideology and moral dilemma for the children. The author wants to share the latter with readers and stimulate discussion. Mourning and traditional grieving is encouraged in many cultures; can this not tantamount to systematic grief therapy? In many cultures, grief, and bereavement, through ages, have inspired renowned poets and scientists to express their viewpoints.

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