Background: The elderly population is large in general and growing due to advancement of health care education. These people are faced with numerous physical, psychological and social role changes that challenge their sense of self and capacity to live happily. Many people experience loneliness and depression in old age, either as a result of living alone or due to lack of close family ties and reduced connections with their culture of origin, which results in an inability to actively participate in the community activities. With advancing age, it is inevitable that people lose connection with their friendship networks and that they find it more difficult to initiate new friendships and to belong to new networks. The present study was conducted to investigate the relationships among depression, loneliness and sociability in elderly people. Materials and Methods: This study was carried out on 55 elderly people (both men and women). The tools used were Beck Depression Inventory, UCLA Loneliness Scale and Sociability Scale by Eysenck. Results: Results revealed a significant relationship between depression and loneliness. Conclusion: Most of the elderly people were found to be average in the dimension of sociability and preferred remaining engaged in social interactions. The implications of the study are discussed in the article.

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Electroencephalography (EEG) provides an excellent medium to understand neurobiological dysregulation, with the potential to evaluate neurotransmission. Time-locked EEG activity or event-related potential (ERP) helps capture neural activity related to both sensory and cognitive processes. In this article, we attempt to present an overview of the different waveforms of ERP and the major findings in various psychiatric conditions.

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Hypothesis testing is an important activity of empirical research and evidence-based medicine. A well worked up hypothesis is half the answer to the research question. For this, both knowledge of the subject derived from extensive review of the literature and working knowledge of basic statistical concepts are desirable. The present paper discusses the methods of working up a good hypothesis and statistical concepts of hypothesis testing.

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Background: Three to nine per cent of teenagers meet the criteria for depression at any one time, and at the end of adolescence, as many as 20% of teenagers report a lifetime prevalence of depression. Usual care by primary care physicians fails to recognize 30-50% of depressed patients. Materials and Methods: Cross-sectional one-time observational study using simple screening instruments for detecting early symptoms of depression in adolescents. Two psychological instruments were used: GHQ-12 and BDI. Also socio­demographic data (e.g. academic performance, marital harmony of parents, bullying in school, etc) was collected in a separate semi-structured performa. Statistical analysis was done with Fisher's Exact Test using SPSS17. Results: 15.2% of school-going adolescents were found to be having evidence of distress (GHQ-12 score e"14); 18.4% were depressed (BDI score e"12); 5.6% students were detected to have positive scores on both the instruments. Certain factors like parental fights, beating at home and inability to cope up with studies were found to be significantly (P <0.05) associated with higher GHQ-12 scores, indicating evidence of distress. Economic difficulty, physical punishment at school, teasing at school and parental fights were significantly (P <0.05) associated with higher BDI scores, indicating depression. Conclusion: The study highlights the common but ignored problem of depression in adolescence. We recommend that teachers and parents be made aware of this problem with the help of school counselors so that the depressed adolescent can be identified and helped rather than suffer silently.

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Background: The relationship between glucose metabolism and psychiatric illness is under the focus of clinicians for centuries. Depending on the definition used, the prevalence of depression among diabetics ranges from 8.5% to 32.5%, while that for anxiety disorders it is up to 30%. Aims and Objectives : To assess the prevalence of psychiatric morbidity among diabetic patients using standardized rating scales for depression and anxiety. Materials and Methods: One hundred diagnosed patients of diabetes were assessed on the Hamilton rating scale for depression and the Hamilton rating scale for anxiety, who were attending the diabetic clinic. They were assessed on sociodemographic profile, duration of illness, type of treatment, and oral vs insulin, and then the data were analyzed on different domains. Results: About 84% of the patients had comorbid depression. Females showed a high percentage of depression and anxiety, and the severity level was also higher in the females. Genital symptoms were usually reported by the males, while somatic symptoms were more prevalent in the females.

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Delirium tremens is recognized as a potentially fatal and debilitating complication of alcohol withdrawal. Use of sedatives, particularly benzodiazepines, is the cornerstone of therapy for delirium tremens. But sometimes, very heavy doses of benzodiazepines are required to control delirious symptoms. We are reporting one such case of delirium tremens, which required very heavy doses of benzodiazepines and was ultimately controlled by using infusion of propofol. Thus propofol should always be considered as an option to treat patients with resistant delirium tremens.

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Background: Few studies have evaluated the supernatural beliefs of patients with schizophrenia. This study aimed to study the personal beliefs, aetiological models and help seeking behaviour of patients with schizophrenia using a self-rated questionnaire. Materials and Methods: Seventy three patients returned the completed supernatural Attitude questionnaire. Results: 62% of patients admitted that people in their community believed in sorcery and other magico-religious phenomena. One fourth to half of patients believed in ghosts/evil spirit (26%), spirit intrusion (28.8%) and sorcery (46.6%). Two-third patients believed that mental illness can occur either due to sorcery, ghosts/evil spirit, spirit intrusion, divine wrath, planetary/astrological influences, dissatisfied or evil spirits and bad deeds of the past. 40% of the subjects attributed mental disorders to more than one of these beliefs. About half of the patients (46.6%) believed that only performance of prayers was sufficient to improve their mental status. Few patients (9.6%) believed that magico-religious rituals were sufficient to improve their mental illness but about one-fourth (24.7%) admitted that during recent episode either they or their caregivers performed magico-religious rituals. Conclusion: Supernatural beliefs are common in patients with schizophrenia and many of them attribute the symptoms of mental disorders to these beliefs.

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Background: Anxiety may not be recognized by physicians though they affect a large number of patients awaiting surgery as reported in some studies. Good doctor-patient communication may have an impact on preoperative anxiety. Aim: To find out the incidence of anxiety in patients awaiting surgery and its association with good doctor-patient communication. Materials and Methods: The study was undertaken in a medical college hospital situated in an industrial township, for the duration of two months. It was a cross-sectional study. The study included 79 patients admitted to various surgical wards of a teaching hospital. Data was collected on a pretested questionnaire, which included a set of questions on various aspects of doctor-patient communication. The level of anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS). Statistical analysis was carried out using the WHO/CDC package EPI INFO 2002. Though preoperative anxiety was collected on an ordinal scale, later during analysis, it was collapsed to give a categorical scale. Aspects of doctor-patient communication associated with preoperative anxiety were explored by Chi square tests. Results: Out of the total 79 patients, 26.5% reported definite anxiety levels. Good doctor-patient communication was found to be inversely associated with anxiety levels in the preoperative period. Conclusions: Preoperative anxiety is a common phenomenon among indoor surgical patients. A lot can be done to alleviate this anxiety by improving doctor-patient communication.

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Context: Depression affects about 20% of women during their lifetime, with pregnancy being a period of high vulnerability. Prevalence of depression during pregnancy ranges from 4% to 20%. Several risk factors predispose to depression during pregnancy including obstetric factors. Depression during pregnancy is not only the strongest risk factor for post-natal depression but also leads to adverse obstetric outcomes. Aims: To study the prevalence of depression during pregnancy and its associated obstetric risk factors among pregnant women attending routine antenatal checkup. Settings and Design: Cross-sectional observational survey done at the outpatient department (OPD) of the department of obstetrics of a tertiary care hospital in Navi Mumbai. Materials and Methods: One hundred and eighty-five pregnant women were randomly administered the Beck Depression Inventory (BDI) for detecting depression. Additional socio-demographic and obstetric history was recorded and analyzed. Results: Prevalence of depression during pregnancy was found to be 9.18% based upon BDI, and it was significantly associated with several obstetric risk factors like gravidity (P = 0.0092), unplanned pregnancy (P = 0.001), history of abortions (P = 0.0001), and a history of obstetric complications, both present (P = 0.0001) and past (P = 0.0001). Conclusions: Depression during pregnancy is prevalent among pregnant women in Navi-Mumbai, and several obstetric risk factors were associated to depression during pregnancy. Future research in this area is needed, which will clearly elucidate the potential long-term impact of depression during pregnancy and associated obstetric risk factors so as to help health professionals identify vulnerable groups for early detection, diagnosis, and providing effective interventions for depression during pregnancy.

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Pediatric obesity is a major health problem and has reached epidemiological proportions today. The present paper reviews major psychological issues in pediatric obesity from a developmental perspective. Research and literature has shown that a number of developmental, family, maternal and child factors are responsible in the genesis of pediatric obesity. Family food habits, early developmental lifestyle of the child, parenting, early family relationships and harmony all contribute towards the growth and development of a child. The present review focuses on the role of developmental psychological factors in the pathogenesis of pediatric obesity and highlights the developmental factors that must be kept in mind when evaluating a case of pediatric obesity.

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Research studies are usually carried out on sample of subjects rather than whole populations. The most challenging aspect of fieldwork is drawing a random sample from the target population to which the results of the study would be generalized. In actual practice, the task is so difficult that some sampling bias occurs in almost all studies to a lesser or greater degree. In order to assess the degree of this bias, the informed reader of medical literature should have some understanding of the population from which the sample was drawn. The ultimate decision on whether the results of a particular study can be generalized to a larger population depends on this understanding. The subsequent deliberations dwell on sampling strategies for different types of research and also a brief description of different sampling methods.

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The literature on hallucinations is reviewed, including its occurrence in different psychiatric disorders, neurological disorders and normal persons. The diagnostic significance of hallucinations is also discussed. Reports of hallucinations in normal people are reviewed. The different modes of the management of hallucinations are briefly discussed.

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Objective: To determine body image satisfaction among newly entrant women students in a professional institution. Materials and Methods: A cross-sectional study using body image satisfaction described in words was undertaken, which also explored relationship with body mass index (BMI) and other selected co-variables such as socio-demographic details, overall satisfaction in life, and particularly in academic/professional life, current health status using 5-item based Likert scale. Height, weight, hip and waist circumference measurement was carried out using standard protocol. Data collection was carried through personal interview using pre-designed, pre-tested semi-structured interview schedule by female investigators during August-September 2010 and analysis carried out by computing percentages and Chi-square test. Results: Out of 96 study samples, 16.66%, 51.04%, and 32.29% girl students perceived their body image as fair, good and excellent, respectively while overall 13.54% were dissatisfied with their body image. The body image satisfaction had significant relationship with image perception ( P<0.001), current general health status ( P<0.001) and self weight assessment ( P<0.001). Mother's education had a statistically significant ( P=0.004) but negative relationship with outcome variable. Students with low weight (BMI <18.5 kg/m²) had a significantly higher (85.71%) prevalence of body image satisfaction while overweight students (BMI≤23 kg/m²) had a significantly higher (54.54%) prevalence of dissatisfaction ( P<0.001). Discussion: High body image satisfaction is reported in this study and was found to be significantly related to anthropometric measurements. On an encouraging note, this level needs to be preserved for overall mental and healthy development of students. Proactive preventive measures could be initiated on personality development, acceptance of self and individual differences while maintaining optimum weight and active life style.

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The main objective of presenting the case series is that despite dramatic symptomatic response by intra venous lorazepam or electro convulsive therapy irrespective of primary diagnosis in catatonia cases some cases remain difficult to treat by conventional treatment. Here, we present five catatonia cases who did not respond to conventional treatment even when treated for primary psychiatric diagnosis along with treatment for catatonia. They ultimately responded partially or completely to clozapine only, which explains the multi-factorial causation of catatonia syndrome as postulated by different scientific research.

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Background: Scientific studies demonstrate efficacy of yogic treatment methods in stress and anxiety related disorders, psychosomatic disorders and physical illness. Very few studies have been conducted on schizophrenic patients. Aims: This study was conducted to determine the efficacy of yoga therapy on subjective well-being, basic living skills, self-care, interpersonal, communicational and routine functions of schizophrenic patients. Materials and Methods: Thirty chronic schizophrenic hospitalized patients were selected from Ranchi Institute of Neuro-Psychiatry and Allied Sciences, Ranchi and were randomly assigned to the experimental group (yoga therapy along with Pharmacotherapy, n=15), and to control group (Pharmacotherapy alone, n=15). Baseline assessment was done using Post Graduate Institute general well-being measure (GWBM), Checklist for basic living skills and Indian disability evaluation and assessment scale (IDEAS). The experimental group attended yoga therapy every day for about 1΍ h including motivational and feedback session. After 1 month post-assessment was done for both the groups. Statistical Analysis: Pearson Chi-square test was used for comparing the results. Results: At the end of 1 month experimental group showed better rating in comparison to control group in PGI GWBM, basic living skills and IDEAS. Conclusion: Yoga could improve patients' subjective well-being, their daily basic living functioning, personal hygiene, self-care, interpersonal activities and communication, and prompted more involvement in routine work.

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Background: A number of studies from the western world have explored the negative beliefs held by individuals towards people with mental illness. The knowledge of attitude and awareness of undergraduate medical students towards psychiatry, mental health and mental disorders is of utmost importance. Objective: The current study aims at assessment of attitudes of medical students towards mental illness and mentally ill. Materials and Methods: The study used a cross-sectional survey design. The instruments used included Beliefs toward Mental Illness (BMI) scale, Attitudes to Mental Illness Questionnaire (AMIQ). ANOVA was carried out to compare the in between group differences for the four study groups. Additionally Bonferroni correction was used to conduct the post hoc analysis. Results: The interns were significantly more likely to agree with the statement that the mental disorders are recurrent; less likely to be of thought that the behavior of people with mental disorders is unpredictable; more likely to disagree with the fact that diagnosis of depression as described in the case vignette was going to damage the career of the individual; more likely to agree with the option of inviting a depressed person to a party; more likely to believe in fact that mentally ill individuals are more likely to be criminals as compared to medical students in different professional years. Conclusions: Adequate modifications to existing medical curriculum would help improve attitude of medical students towards mentally ill.

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Background: In our society, adherence to feminine traits by the female gender had been culturally promoted and socially desired. A few studies, however, entertained the possibility that healthy men and women have some common attributes in their gender orientation. Androgyny and masculinity were found related to positive mental health. Materials and Methods: A cross-sectional study was conducted to assess the level of masculinity and femininity and its relationship with the perception of stress and various psychopathology including anxiety and depression. Results: Masculinity scores of the participants negatively correlated while femininity scores positively correlated with the scores on General Health Questionnaire, Beck's Depressive Inventory, Beck's Anxiety Inventory, and Perceived Stress Scale. Conclusion: Androgyny is psychoprotective. Empowerment-oriented psychological approaches aimed to encourage psychological androgyny, and masculinity might be therapeutic.

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Background: The objective was to study the sociodemographic data, psychiatric disorder, precipitating events, and mode of attempt in suicide attempted patients referred to consultation liaison psychiatric services. Settings and Design: A prospective study of 6-month duration was done in a tertiary care center in India. Materials and Methods: During the 6-month period all referrals were screened for the presence of suicide attempters in consultation liaison services. Those who fulfilled the criteria for suicide attempters were evaluated by using semistructured pro forma containing sociodemographic data, precipitating events, mode of attempt, and psychiatric diagnosis by using ICD-10. Results: The male-to-female ratio was similar. Adult age, urban background, employed, matriculation educated were more represented in this study. More than 80% of all attempters had psychiatric disorder. Majority had a precipitating event prior to suicide attempt. The most common method of attempt was by use of corrosive. Conclusions: Majority of suicide attempter patients had mental illness. Early identification and treatment of these disorders would have prevented morbidity and mortality associated with this. There is a need of proper education of relatives about keeping corrosive and other poisonous material away from patients as it was being commonest mode of attempt.

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Background: Research on anger attacks has been mostly limited to depression, and only a few studies have focused on anger attacks in obsessive compulsive disorder. Materials and Methods: In a cross-sectional study all new obsessive compulsive disorder patients aged 20-60 years attending an outpatient clinic were assessed using the anger attack questionnaire, irritability, depression and anxiety scale (for the direction of the aggressive behavior) and quality of life (QOL). Results: The sample consisted of 42 consecutive subjects with obsessive compulsive disorder, out of which 21 (50%) had anger attacks. The obsessive compulsive disorder subjects with and without anger attacks did not show significant differences in terms of sociodemographic variables, duration of illness, treatment, and family history. However, subjects with anger attacks had significantly higher prevalence of panic attacks and comorbid depression. Significantly more subjects with anger attacks exhibited aggressive acts toward spouse, parents, children, and other relatives in the form of yelling and threatening to hurt, trying to hurt, and threatening to leave. However, the two groups did not differ significantly in terms of QOL, except for the psychological domain being worse in the subjects with anger attacks. Conclusion: Anger attacks are present in half of the patients with obsessive compulsive disorder, and they correlate with the presence of comorbid depression.

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Background: Yoga Nidra is a successful therapy for both recent and long-standing psychological disturbances of all kinds especially depression and high anxiety level and neurotic patterns. Objective: The purpose of the present work, therefore, was to conduct a preliminary randomized study of Yoga Nidra as a treatment in the patients of menstrual disorders with somatoform symptoms. Materials and Methods: Patients were recruited from Department of Obstetrics and Gynecology, CSM Medical University (erstwhile KGMU) Lucknow, Uttar Pradesh, India. One hundred and fifty female patients with menstrual disorders were randomly divided in to two groups 1- Intervention group: 75 subjects (Yoga Nidra intervention and medication) 2- control group: 75 subjects (without Yoga Nidra intervention only medication). Schedule for clinical assessment in neuropsychiatry tool was used. Results: There was significant improvement in pain symptoms (P<0.006), gastrointestinal symptoms (P<0.04), cardiovascular symptoms (P<0.02) and urogenital symptoms (P<0.005) after 6 months of Yoga Nidra therapy in Intervention group in comparison to control group. Conclusion: Yoga Nidra appears to be a promising intervention for psychosomatic problems. It is cost-effective and easy to implement. The results indicate that somatoform symptoms in patients with menstrual disorder can be decreased by learning and applying a program based on Yogic intervention (Yoga Nidra).

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Background: Motivation of health workers is necessary to generate the organizational commitment towards the patients and the hospital and therefore the knowledge about what motivates and satisfies them is very essential.The aim of the project was to investigate and analyze the various factors that help in motivation of the health workers while performing their clinical duties in the hospital. Materials and Methods: A simple random study was conducted among 100 employees of our institute, which included doctors, staff nurses and paramedical staff. One hundred employees from Gian Sagar Institute were chosen randomly for the purpose of our study. All the employees were enquired by the questionnaire method as well as by individual interviews regarding the various motivating and demotivating factors at the work place. Detailed enquiries were performed regarding the various aspects concerning the job factors and work satisfaction. All the answers and findings were observed and recorded. Results: Statistical Analysis Used: Simple non-parametric tests like mean, percentages and chi square tests were employed to analyze the data.The demographic profile of all the employees showed only minor differences which were statistically non-significant. Skills, task identity, task significance, autonomy, feedback, environment, job security and compensation were observed to be the important factors for the motivation of employees. The depth and the extent to which these factors were studied at work in the hospital showed remarkable differences. Conclusion: All the factors studied in this project are essential basis for organizational commitment, but feedback represents the factor with the highest motivation potential especially among the younger population.

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Context: Diabetes affects 9.2% of adults in India. About 8-16% of its population also suffer from depression. Both diseases pose a serious health challenge at individual and system level. The prevalence of depression in diabetes is much higher than in the general population. Undiagnosed and untreated depression puts people at higher morbidity and mortality risk. Aim: To study the prevalence of depression in diabetes and to identify associated risk factors. Settings and Design: Case control study carried out in an outpatient setting of a tertiary hospital in central India. Materials and Methods: One hundred and nine type 2 diabetes patients and 91 healthy controls formed the subjects of the study. Sociodemographic data were obtained on seven parameters. Comprehensive clinical data were obtained by means of standard procedures. Blood sugar levels and glycosylated hemoglobin levels were measured to assess glycemic control. Data of diabetic patients and controls as well as that of depressed and nondepressed diabetics were subjected to statistical analysis. Results: About 42.2% of diabetes patients and only 4.39% of controls had depression. About 19% of diabetics had peripheral neuropathy but had much higher neuropathic symptoms. Depression was not related to any sociodemographic or clinical factors but was strongly associated with poor glycemic control. Conclusion: Depression is highly prevalent in diabetes. Physical symptoms mask depression. Special attention needs to be paid to diagnose depression in diabetes and treat it appropriately along with effective glycemic control. Diabetes patients need to be treated collaboratively by physicians and psychiatrists.

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Background: Schizophrenia is a chronic and debilitating psychiatric illness consisting primarily of positive and negative symptoms. However, cognitive deficits in various domains have been consistently replicated in patients with schizophrenia. Therefore, the present study was designed to assess cognitive impairment in schizophrenia and to correlate the same with sociodemographic factors. Materials and Methods: Cognitive function in 100 patients with schizophrenia as per Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM IV-TR) criteria attending the psychiatry outpatient department (OPD) of Department of Psychiatry, SBKS MIRC was assessed using Addenbrooke's Cognitive Examination Revised (ACER) rating scale and Mini Mental State Examination (MMSE) and sociodemographic details was obtained using semistructured proforma. Data was analyzed by Chi-square and t-test. Results: About 70% patients of schizophrenia were found to have cognitive dysfunction for attention, concentration, memory, language, and executive function. Positive symptoms were associated with memory (P<0.001) and attention impairment (P<0.05). Patients with duration of illness >2 years and belonging to urban habitat showed more cognitive dysfunction. Male patients were associated with impairment in two domains of ACER: Language and memory. Conclusion: The study findings depict that persistent cognitive deficits are seen in patients with schizophrenia. Its correlation with sociodemographic factors showed that patients with >2 years of illness and belonging to urban habitat showed more cognitive dysfunction. Male patients were associated with language and memory impairment. Our study recommends that the neurocognitive impairment should be included in the DSM-V diagnostic criteria for schizophrenia.

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Alcohol withdrawal is commonly encountered in general hospital settings. It forms a major part of referrals received by a consultation-liaison psychiatrist. This article aims to review the evidence base for appropriate clinical management of the alcohol withdrawal syndrome. We searched Pubmed for articles published in English on pharmacological management of alcohol withdrawal in humans with no limit on the date of publication. Articles not relevant to clinical management were excluded based on the titles and abstract available. Full-text articles were obtained from this list and the cross-references. There were four meta-analyses, 9 systematic reviews, 26 review articles and other type of publications like textbooks. Alcohol withdrawal syndrome is a clinical diagnosis. It may vary in severity. Complicated alcohol withdrawal presents with hallucinations, seizures or delirium tremens. Benzodiazepines have the best evidence base in the treatment of alcohol withdrawal, followed by anticonvulsants. Clinical institutes withdrawal assessment-alcohol revised is useful with pitfalls in patients with medical comorbidities. Evidence favors an approach of symptom-monitored loading for severe withdrawals where an initial dose is guided by risk factors for complicated withdrawals and further dosing may be guided by withdrawal severity. Supportive care and use of vitamins is also discussed.

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