Indian Journal of Mental Health and Neurosciences
Indian Journal of Mental Health and Neurosciences (IJMHNS) aims to promote and publish research related to mental health and associated neuro-science subjects from across the world. The Journal will be published biannually – in January and in July. The journal encourages clinical and translational research, with the focus on ameliorating the mental illness burden in the community and ensuring evidence based care.
Indian Psychiatric Society - Tamil Nadu Chapter
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Progress, Challenges, and Emerging Risks in Mental Health: The Good, bad and the ugly
Background: Historically, psychotherapy training in India was largely restricted to Cognitive Behavioral Therapy (CBT) and psychoanalytic models, often sidelined by pharmacological interventions due to time constraints and limited specialized personnel. However, the last two decades have seen a paradigm shift characterized by increased patient awareness, a diversification of therapeutic modalities, and the emergence of structured interventions for complex conditions like Borderline Personality Disorder (BPD). Objectives: This paper aims to reflect on the evolving journey of psychotherapy in India, specifically examining the practical application, challenges, and clinical utility of Mentalization-Based Treatment (MBT) and Dialectical Behaviour Therapy (DBT). Methods: The authors utilize a reflective, practice-based narrative drawing from their clinical experience as psychiatrists trained in both Indian and international settings. Case vignettes are employed to illustrate the cultural adaptations and systemic barriers encountered while delivering structured therapies in the Indian context. Results: The transition to specialized therapies reveals unique socio-cultural challenges: systemic barriers like the dual role of the psychiatrist as both a prescriber and therapist necessitating clear boundary setting; cultural dynamics: collectivistic family structure challenging autonomy and confidentiality; implementation hurdles: scarcity of trained supervisors, high training cost, lack of a centralised database particularly outside urban centres. Conclusion: While psychotherapy in India has gained significant momentum and acceptance, there is a pressing need for standardized training, peer supervision networks, and culturally sensitive adaptations of Western models. The shift from symptom management to addressing underlying psychological distress through MBT and DBT represents a vital maturation of Indian psychiatric practice.
A study of the prevalence and correlates of suicidal ideation and psychiatric morbidity among undergraduate medical students in Tamil Nadu, India
Background: Understanding the risk factors for psychiatric morbidity and suicidal ideation among medical undergraduates is gaining importance given the increasing trend in suicides among this population. This study aimed to analyze the prevalence of suicidal ideation, depression, and anxiety among medical undergraduates and to compare their socio-demographic, familial, and behavioral characteristics to identify potential risk factors. Methods: We performed a cross-sectional online survey among 500 consenting medical undergraduates in Tamil Nadu, South India. Ethical approval was obtained. We used a semi-structured proforma to obtain the sociodemographic, family relationships, and lifestyle information of our participants. The beck depression inventory and the hospital anxiety depression scale were used to quantify depression and anxiety among our students. We performed univariate and multivariate logistic regression analyses and computer-based predictive modelling using Classification and Regression Tree (CART) analysis on our data. Results: We found a prevalence of 20.2% for suicidal ideation, 35.8% for depression, and 53% for anxiety among our students. Significantly increased odds of having suicidal ideation were observed among students who were from disharmonious families (odds ratio [OR] = 10.80; CI: 9.30–30.15; p = 0.008), had poor satisfaction with maternal love (OR = 2.21; CI: 0.79–3.34; p = 0.03), frequently visited shopping malls (p = 0.05; OR = 5.71; CI: 0.88–17.12) and never exercised (OR = 1.95, CI: 0.81–2.74; p = 0.03). Significantly lower odds of suicidal ideation were observed among students who consumed food with friends in restaurants on weekends (OR = 0.08; CI: 0.01– 0.045; p = 0.005). We observed lower odds of anxiety and depression among students who visited religious places (OR = 0.49; CI: 0.04–3.13; p = 0.05) and places of sightseeing (OR = 0.45; CI: 0.07–2.94; p = 0.05), respectively. Among students who reported difficulty in decision-making, CART analysis predicted 36.1% of suicidal ideation, 74.6% of depression, and 80.5% of anxiety. Increased fatiguability, feelings of unattractiveness, and feelings of being punished predicted depression among 49.2% of our students. Ideas of guilt and blaming oneself predicted anxiety among 66.5 and 68.4% of our students, respectively. Conclusions:One-fifthofmedicalgraduatesreportedsuicidalideation,one-thirdexperienceddepression,andhalf had anxiety, with risk factors including poor relationships with family and classmates, female gender, academic stress, substance use, and lack of exercise. CART analysis identified depression as the strongest predictor of anxiety and suicidal ideation, with decision-making difficulties and fatigue being significant contributors. CART has demonstrated high accuracy, highlighting its value in clinical research.
Impact of cannabis use in patients with schizophrenia- a cross sectional comparative study
Background: Cannabis has become one of the key substances attracting increasing attention in recent times, particularly for its association with psychotic disorders. Neurological soft signs (NSS) are subtle motor and sensory integration abnormalities observed in schizophrenia, reflecting underlying neurodevelopmental dysfunction. Cannabis use is increasingly prevalent in schizophrenia and may influence the clinical and neurobiological phenotype, including NSS. Aim: To compare NSS and psychopathology in schizophrenia patients with and without cannabis use. Materials and methods: A comparative cross-sectional study was conducted among 60 male patients diagnosed with schizophrenia (DSM-5 criteria), divided equally into two groups: those with (n = 30) and without (n = 30) cannabis use. Cannabis use of more than 2 years’ duration was confirmed using the Cannabis Use Disorder Identification Test–Revised (CUDIT-R) and the Severity of Dependence Scale (SDS). The Neurological Evaluation Scale (NES), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), and Brief Psychiatric Rating Scale (BPRS) were administered. Statistical analysis was performed using SPSS v26.0. Results: Cannabis users showed significantly lower scores in the NES domain “sequencing of complex motor acts” (p = 0.042), suggesting better motor coordination. No significant differences were observed in total NSS or other subdomains. Cannabis users had significantly higher SAPS (p = 0.036) and BPRS scores (p = 0.014) and lower SANS scores (p = 0.010), indicating greater positive symptoms, overall psychopathology, and lesser negative symptoms. Among users, the mean CUDIT-R score was 6.26 ± 7.32, and the SDS score was 3.16 ± 3.52. Half of the users initiated cannabis between ages 16 and 20, and 43.4% used it weekly. Conclusion: Schizophrenia patients with cannabis use exhibited milder deficits in certain NSS domains and a higher positive symptom burden. These findings suggest a distinct clinical profile and possible neurodevelopmental variation, underlining the importance of screening for cannabis use.
Evolving legal standards in Tamil Nadu’s healthcare, data protection, and public safety
Copyright (c) 2026 C. Sadhanand https://creativecommons.org/licenses/by/4.0
Bloody Tears: A Rare Presentation of Munchausen Syndrome
Background: Haemolacria, or bloody tears, is a rare and alarming clinical presentation with a broad differential diagnosis encompassing ocular, systemic, and psychological causes. Factitious disorder imposed on self (previously known as Munchausen syndrome) is characterized by the deliberate fabrication of symptoms to assume the sick role and is particularly challenging to identify in adolescents. Awareness of this association is limited, often leading to extensive and unnecessary investigations. Case Presentation: A 17-year-old female presented with a six-month history of intermittent, painless bleeding from both eyes. Episodes were sudden, not associated with trauma, menstruation, or systemic illness, and caused significant distress to her family, while the patient remained relatively unconcerned. Comprehensive ophthalmic, hematological, and radiological evaluations, including CT and MR angiography, revealed no abnormalities. Mental state examination revealed anxiety related to familial stressors, particularly concerns about her father’s health and financial insecurity. Diagnosis: Following detailed psychiatric assessment and psychotherapy, the patient disclosed deliberate fabrication of symptoms using red watercolour paint to simulate bleeding episodes during periods of emotional stress, primarily to gain attention and care. A diagnosis of factitious disorder imposed on self presenting as haemolacria was established. Management and Outcome: An eclectic psychotherapeutic approach focusing on insight development, addressing maladaptive coping mechanisms, and enhancing stress management skills was initiated. Regular follow-up sessions resulted in significant symptomatic improvement and cessation of fabricated bleeding episodes. Conclusion: This case highlights haemolacria as a rare but striking manifestation of factitious disorder in adolescents. It underscores the importance of considering psychiatric etiologies after exclusion of organic causes, particularly in unexplained and recurrent presentations. Early recognition can prevent unnecessary investigations, reduce iatrogenic harm, and facilitate timely psychological intervention.
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Information from the external world enters the mind through the five special senses, forming perception that influences thoughts and emotions. The interaction of thoughts and emotions leads to the formation of impulses, which remain internal until expressed through speech or action, resulting in self-experience. The conversion of impulse into expression is regulated by experience derived from genetic factors, bodily sensations, others’ experiences, and self-experience. Experience guides impulse expression by considering contextual factors such asplace,meaning,andsituation,highlightingtheroleofsensoryinputandexperientialregulationinshapinghuman behavior.
Ayurveda, Homeopathy and other complementary treatments in the child and adolescent mental health: A critical review of emerging paradigms
The prevalence of child and adolescent mental health disorders, including ADHD, anxiety, depression, and autism spectrum disorders, is increasing globally, necessitating diverse treatment approaches. While conventional psychiatric interventions such as pharmacotherapy and psychotherapy remain the standard of care, their limitations—including side effects, treatment resistance, and accessibility challenges—have led to a growing interest in Complementary and Alternative Medicine (CAM). Ayurveda, homeopathy, and other CAM interventions are widely used, particularly in low- and middle-income countries, where up to 97% of the population relies on traditional medicine. Despite their popularity, scientific validation of these treatments remains limited, with inconsistent evidence regarding their efficacy, safety, and feasibility for integration into mainstream psychiatric care. This review examines the role of CAM in child and adolescent psychiatry, highlighting potential benefits and limitations based on a comprehensive literature search across major databases, expert discussions from an academic seminar, and survey responses from clinicians. Findings suggest that Ayurvedic practices such as “Sattvavajaya” (a cognitive-behavioral therapy analog), homeopathic remedies, and mind-body interventions like yoga and mindfulness show promise for managing psychiatric conditions. However, regulatory challenges, quality control concerns, and insufficient clinical validation hinder their integration into evidence-based mental healthcare. Further rigorous research, standardized treatment protocols, and interdisciplinary collaboration are essential to determine the role of CAM in pediatric psychiatry. Medical education must also incorporate CAM-related training to equip clinicians with the knowledge necessary to guide patients and caregivers effectively.
Climate change and the mental health of older adults in India: a geropsychological perspective on risk, resilience, and policy gaps
Background: Climate change is emerging as a major public health threat with significant mental health consequences. Older adults in India, due to physical frailty, cognitive decline, and limited social protection, are uniquely vulnerable to these climate stressors. Despite their heightened susceptibility, the intersection of climate change and geriatric mental health remains underexplored in India. Methods: This review synthesizes existing national and international literature on the mental health impacts of climate change among older adults, particularly in the Indian context. Databases searched include PubMed, Scopus, and Indian Journals Online. Grey literature and policy documents were also reviewed. Results: Evidence indicates that older adults are disproportionately affected by heatwaves, floods, droughts, and climate-induced displacement. Key psychiatric outcomes include depression, anxiety, post-traumatic stress disorder, and suicide. Challenges include limited access to care, infrastructural inadequacies, and the breakdown of familial support. Protective factors include community engagement, intergenerational support, and culturally sensitive mental health interventions. Conclusion: There is a pressing need for India to incorporate geriatric mental health into its climate adaptation and mental health strategies. Future research must focus on building climate-resilient mental health systems with a geropsychological lens.
Letter to editor: mental health and neuroscientific impact of the blind box toy consumption
Blind box toys are popular, but long-term addiction to such products can have negative impacts on mental health problems such as depression, anxiety, and suicide risks. Previous researchers have emphasized that players experience happiness and look forward to the blind box toy they purchase. Unpredictable contents in a blind box trigger dopamine release, and when a dopamine rush can be addictive, it leads individuals to buy more to gain potentially rare or desirable items, resulting in financial losses, buyer’s remorse, and immersion in surprise and disappointment for the gambling-like physical products. What feelings are blind box consumers pursuing? Blind box collectables offer a more exciting experience than buying transparently packaged items, and they provide participants with the hedonic value when imagining what could be inside in the pre-opening phase. That is, blind box toys’ unknown attributes were quite attractive to consumers. Blind box toys are sold in opaque packaging which allows consumers to possess a sense of mystery, as the emotional value exceeds the utilitarian value, and derive enjoyment and satisfaction from them. From a consumer behavior perspective, being blind is perceived as uncertainty; positive emotions of surprise and feelings of winning are accompanied by curious consumers because they perceive themselves as lucky, estimating outcomes optimistically.
Patterns of psychiatric morbidity in patients attendingpsychiatric OPD of Government Medical College Anantnag
Background: Psychiatric morbidity is a significant public health concern globally, with disparities in access and awareness exacerbating the burden in resource-limited settings like Kashmir. The region’s socio-political instability and cultural factors have compounded mental health issues, necessitating region-specific studies to assess psychiatric patterns. Objective: To evaluate the prevalence and patterns of psychiatric disorders among patients attending the Psychiatry Outpatient Department (OPD) at Government Medical College, Anantnag, Kashmir, and identify sociodemographic associations. Methods: This cross-sectional, descriptive study was conducted over six months, enrolling 933 patients aged =12 years using consecutive sampling. Sociodemographic and clinical data were collected through structured proformas and DSM-5 diagnostic criteria. Statistical analyses, including descriptive and inferential tests, were performed using SPSS Version 20.0. Results: Of the 933 participants (mean age 32.9 years, 61.3% females), major depressive disorder (23.7%) was the most prevalent diagnosis, followed by obsessive-compulsive disorder (19.3%) and bipolar affective disorder (10.5%). Anxiety disorders collectively accounted for 8.7%, while schizophrenia and PTSD had lower prevalence rates (2.6% and 0.8%, respectively). Females were disproportionately affected by OCD (19.9%) and major depressive episodes (15.4%). Panic disorders and dementia were more common among males. Younger participants predominantly presented with anxiety-related disorders, while older individuals exhibited higher rates of dementia and cognitive impairments. Homemakers (37.9%) and students (30.3%) formed the largest occupational groups. Conclusion: The study highlights a high burden of depressive and anxiety disorders in Kashmir, influenced by gender, age, and sociocultural factors. Females exhibited higher rates of affective disorders, while younger individuals reported anxiety-related conditions. These findings underscore the need for gender- and agespecific mental health interventions and culturally sensitive policies to address the unique challenges faced by Kashmir’s population.
Copyright (c) 2025 Nadeem Bashir, Syed Zuhare, Mansoor Ahmad Dar, Javed Ahmad Sheikh, Rehana Amin, Muntaqueem ul kousar, Mehroosh Roub, Rasikha Rasool Khan https://creativecommons.org/licenses/by/4.0
Prisoners acquitted on the grounds of unsoundness of mind and admitted in a mental health establishment – a case series
Background: Individuals acquitted on grounds of unsoundness of mind and admitted in a mental healthcare facility as per section 335 of the Criminal Procedure Code (CrPC) represent a unique intersection of psychiatric morbidity and legal oversight. This study details the nature of criminal offence, the psychiatric illness, and related factors in such individuals resulting in prolonged stay in psychiatric establishments after legal acquittal. Material and Methods: This retrospective case series examined medico-legal records of five individuals admitted to a tertiary psychiatric facility between 2015 and 2022. Data were extracted on sociodemographic characteristics, psychiatric diagnoses, nature of offences, legal proceedings, and duration of stay in the mental health establishment. Results: All individuals were diagnosed with Schizophrenia and had committed serious offences—primarily homicide—during active psychotic episodes. None had received adequate psychiatric treatment just before the offense. There were delays in rendering the individual fit to stand trial due to chronic severe mental illness, which contributed to a prolonged hospital stay, often exceeding 5 years. Discharge and reunion with family members could not be achieved in these patients due to long-standing mental illness. Conclusion: This case series highlights the complex clinical and legal journeys of individuals acquitted on grounds of unsoundness of mind. Prolonged inpatient stay remains common, often due to chronicity of illness and limited family support, emphasizing the need for regular psychiatric treatment, developing structured discharge protocols, expanding community-based rehabilitation options, and improving legal awareness among caregivers.
Copyright (c) 2026 Sajitha Shifana A, Dr Karthikeyan V, Dr PP Kannan https://creativecommons.org/licenses/by/4.0
The Role of Psychiatrists in Mental Health Care Delivery Spectrum: Addressing the Challenge sand Expanding the Scope
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Copyright (c) 2024 The Author(s). https://creativecommons.org/licenses/by/4.0
The research interface between psychiatry and medicine: Evolving paradigms and their implications
Copyright (c) 2024 Indian Journal of Mental Health and Neurosciences https://creativecommons.org/licenses/by/4.0/
ENCHANT - Enhancing Psychiatric History Taking: A Comprehensive Approach
Factors Affecting Adherence to Oral Medications in Chronic Psychiatric Patients at a Tertiary Care Hospital in Western India: A Cross-Sectional Study
Background: Adherence to Medications has been identified as an important factor in determining the course of psychiatric illness and future recovery. Despite this fact, lower adherence rates have been reported. Aim: To determine the level of adherence to oral medications in chronic psychiatric patients and to assess factors affecting adherence. Methods: A cross-sectional study was conducted on 225 patients diagnosed with and on treatment for Psychiatric Conditions for more than three months at the Outpatient Department of Psychiatry of a tertiary care hospital in Western India from September to October 2023. Data were collected using a Case Report Form and a standardized Adherence to Refills and Medications Score (ARMS) Questionnaire. Both bivariate and multivariate logistic regression were used. Variables with p-value < 0.05 were considered statistically significant. Results: Majority of the study population (87.6%) was found to be non-adherent. Through univariate logistic regression, it was found that the female gender (OR: 2.425; 95% CI: 1.020 – 5.766), higher education of head score (OR: 2.410; 95% CI: 1.063 – 4.758), and lesser number of class of medications (OR: 2.315; 95% CI: 1.037 – 5.166) were significant predictors of adherence. Multivariate logistic regression showed that higher education of head score (AOR: 2.705; 95% CI: 1.144 – 6.398) and lower frequency of consumption of medications (AOR: 0.335; 95% CI: 0.135 – 0.829) were associated with better adherence. Conclusion: The study showed that further improvements in adherence are required. Factors contributing to non-adherence should be assessed and intervened.
Assessment of association between pregnancy induced hypertension and cognitive function: Before and after one month of delivery: Cohort study
Introduction: Pre-eclampsia is a leading cause of morbidity and death in mother and baby. This also leads to endothelial dysfunction in large and small vessels, which leads to cognitive impairment. This is the first kind of study from India on the assessment of cognitive function in the Pregnancy-induced hypertension (PIH) group. Materials and Method: We recruited cases from the obstetric department’s antenatal care. We applied Socio-demographic data and a Cognitive assessment battery (Trail Making Test (TMT) A and B, PGI memory scale, Porteus maze, and Digit Symbol Substitution Test (DSST)) to collect information on cognitive function. The data was collected from May 2021 to November 2021. Assessment was done during pregnancy and one month after Delivery. Data was assessed using SPSS software. Results: The TMT A and B values were 27.32 & 57.08 predelivery and 23.34 & 48.74 post-delivery. In PGI memory scale (pre and post-delivery values), Remote memory (6.76 & 6.81), recent memory (4.99 & 5.00), mental balance (6.26 &6.75), attention and concentration(7.42 & 8.27), delayed recall (6.29 &6.9), immediate recall(5.13 & 5.70), verbal retention-dissimilar word (9.52 & 10.18) and recognition (6.75 & 7.62) & DSST (88.0 & 91.31), verbal retention for similar words (5.19 &5.34 &)and visual (2.19 & 2.22) retention. The Maze Test-1 (17.29 & 13.06) Maze Test-2 (21.44 & 16.83). Before Delivery, cognitive impairment was present in the Pregnancy Hypertension (PIH) group in trail making, MAZE test, and certain areas of the PGI memory scale, which were statistically significant (<0. 001) compared to the healthy control group. It continues even after one month of Delivery. Conclusion: This study has shown that there was an association between the pregnancy-induced hypertensive group and the healthy control group in certain domains of cognitive function before Delivery. The cognitive impairment persists even after one month of Delivery, which signifies microvascular damage persists for a longer duration.
A community based study in South India of the association between Common Mental Disorders(CMD) and Cognitive Impairment(CI) in urban elderly.
Background: Unprecedented aging in India has brought with it a host of difficulties for the elderly, including urbanization, breakdown of the joint family system, economic distress, poor nutrition and significant unpreparedness to manage their increasing needs. This urgent need was addressed through a formal research proposal aimed to study the prevalence of CMD and CI in community living elderly, their associations and sociodemographic correlates. This detailed analysis thus provides a framework to stimulate policy decisions for elder care in the country. Materials and methods: A prospective cross-sectional study was conducted across six old age homes in Chennai, India where 273 community living elderly aged 65 and older were assessed using the Clinical Interview Scale-Revised and the Mini Mental State Examination (Hindi version). Results: Most of the subjects were female (71.1%), had at least ten years of education and were of high socio-economic status; 52% were positive for CMD and 14.28% had CI. There was a statistically significant association between CMD and CI (t=5.115, p=0.000, 95%CI 8.453-19.034). Conclusions: The prevalence of CI is in keeping with the published literature. However, the prevalence of CMD in this population was found to be higher than that published in literature from India and low- and middle-income countries (LAMIC). Older age, female gender, low educational attainment and middle socio-economic status were factors associated with CI. This study validates the extensively reported finding that CMD and CI are important in the public health implications of human ageing that health planners and policy makers need to focus on.
The role of artificial intelligence in psychiatry
Manganese toxicity presenting as acute psychosis- A case report
Manganese poisoning is a toxic condition due to excessive exposure to manganese which can present with neurological or psychiatric symptoms. Here is a case report of a 51 years old male with occupational history, brought to the Emergency Room with two days history of acute onset behavioural disturbances. There was a history of taking Siddha medications for the last 4 months for polyarthralgia with minimal improvement. A diagnosis of organic psychotic disorder due to Manganese intoxication was made. MRI Brain plain and contrast were normal. The heavy metal screen was suggestive of high Manganese of 42 mg/ml and Cobalt of 4.4 ng/ml EEG was suggestive of generalized epileptiform abnormality. The patient was asked to refrain from further exposure to heavy metals and treated with Sodium valproate and neuro vitamins with gradual improvement in symptoms. This case report emphasizes the need for detailed evaluation and ruling out other medical conditions in a case presenting with the first episode of psychosis.
Prevalence and sociodemographic correlates of depression and anxiety among secondary school students in Chennai, South India: A cross-sectional study
Background: Anxiety and depression are common mental disorders affecting adolescents worldwide and in India. Various factors are associated with the prevalence of anxiety and depression among adolescents, which vary between geographic, socio-cultural, and economic backgrounds. Hence, the aim of the study was to estimate the prevalence of depression and anxiety and assess the socio-demographic factors associated with them among secondary school students in Chennai, south India. Materials and methods: A cross-sectional study was conducted among grade 9 students from four schools in Chennai. Written informed consent was obtained from the parents/guardian and assent from the students before recruitment into the study. The following tools were used to collect data: semi-structured proforma to collect the socio demographic details, perception of stress by Cohen’s Perceived Stress Scale, mental wellbeing by The World Health Organisation- Five Well-Being Index (WHO-5) and anxiety and depression assessed using General Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9), respectively. Results: A total of 569 students (323 (56.8%) boys, 246 (43.2%) girls) participated in the study. Prevalence of anxiety and depression among study participants was 46.3% and 39.6%, respectively. On the multivariate analysis, it was observed that students whose father had a blue-collar job and higher perceived stress were significantly more likely to have anxiety and depression.
depression, anxiety, prevalence, predictors, school, students, Chennai, south India
Atropine induced delirium in young female with unknown snake bite : Case report
Venomous snakebites account for many deaths in developing countries. Administration of an Acetylcholinesterase Inhibitor (ACEI) has been recommended by WHO as a part of neurotoxic snakebite treatment. With atropine being used to reduce the undesirable muscarinic effects of ACEIs, adverse effects like delirium can occur. Delirium is characterized by acute decline in level of consciousness and cognition involving perceptual disturbances, abnormal psychomotor activity, and sleep cycle impairment. This case report describes a 17-year-old female with unknown snakebite who developed atropine induced delirium despite being under the cover of ACEIs and at a lower dose (4.5 mg) than usual for the drug to cause delirium. Though there are reports in literature about atropine induced delirium in organophosphate poisoning, to our knowledge none were reported snakebite cases. Hence, clinicians need to be cautious while encountering with such patients and should always consider the possibility of atropine induced delirium even in snakebite cases.
Impact of COVID-19 outbreak on mental health of undergraduate and postgraduate medical students.
Background: The COVID-19 pandemic, the largest crisis of modern era has subjected medical students and healthcare workers to immense amount of stress due to myriad problems like exposure risk, health concerns and subsequent economic repercussions. Aim: The aim of this study was to estimate the prevalence of depressive symptoms among medical students studying in the sub-continent and in foreign medical universities during the height of the COVID-19 pandemic. Setting and design: This was a cross sectional study. Materials and methods: A web-based survey was conducted using a specially constructed questionnaire pertaining to COVID-19 pandemic. Depressive symptoms were assessed using DASS-21 questionnaire and sleep quality with Pittsburgh Sleep quality index (PSQI), respectively. Statistical analysis: Chi-square tests was used for proportions. Pearson’s correlation analysis was done to evaluate the correlation between study DASS-21 subscales and PSQI. Multiple logistic regression was done to assess the association between study variables and the likelihood of having depressive symptoms. Results: Postgraduate medical students and those studying in foreign universities had a significantly higher prevalence of depression than undergraduates and students studying in Indian universities, respectively. These two sub-groups also had poorer sleep quality (P<0.001). A statistically significant correlation (P<0.001) was observed between depressive symptoms and sleep quality. On multiple logistic regression, post-graduate medical students (OR=3.4), lockdown duration (OR=4.3), poorer PSQI(OR=1.2) and female gender (OR=4.1) had significantly higher odds to exhibit depression. Conclusion: Post-graduate medical students and those studying in foreign medical universities had significantly higher prevalence of depression during the COVID-19 lockdown.
COVID-19; lockdown duration; depression; post-graduates; foreign universities.
Economic burden in patients with dementia attending a geriatric care clinic in Chennai: A cost of illness study
Background: Dementia is one of the major causes of dependency and disability among the elderly. With an increase in life expectancy, the burden of dementia is also on the rise especially in countries like India. There are economic concerns to the family as health expenses are majorly borne by them. There are few cost of illness studies for dementia from low- and middle-income countries. Our study aims to estimate the burden of costs of dementia in patients attending a geriatric clinic in a private hospital setting. Methods: This retrospective observational study assessed the economic burden of dementia by estimating both direct and indirect costs of illness from the caregiver's perspective. Results: Direct costs from medical services and social costs are higher when compared to indirect costs. Not all people have incurred social costs as many are provided care by the families and their inputs are not paid or accounted. The costs of informal care were under evaluated in the study. Conclusion: The direct health care cost of illness of Dementia from caregiver perspective is more than one seventh of the per-capita income of Indian population provided indirect costs and direct social costs are not included. Evaluating various costs incurred in various health care settings is important to understand the economic burden of Dementia. There is a need for well-designed prospective studies to inform policy decisions towards better service development for persons with dementia.
Direct medical costs, Social costs, Indirect costs, LMIC nation
The inaugural issue of Indian Journal of Mental Health and Neurosciences is being published. A brief overview of the journal's aspirations and goals along with an overview of the contents is being provided.
Copyright (c) 2018 Indian Journal of Mental Health and Neurosciences
Elderly Mental Health in Developing Countries
Geriatric Psychiatry deals with specific issues and challenges that arise in the assessment and management of mental health problems in elderly. As a specialty it has not received much attention in developing countries until recently. Elderly will soon be major consumers of mental health care in developing countries. Common psycho-social issues among the elderly and their impact on the mental health in the developing regions of the world and the complex interplay between physical health and mental health in the elderly are described. Dementia and depression are described in some detail focussing on relevant research to highlight the challenges in developing countries. Potential solutions to address the challenges of elderly mental health in developing countries are discussed.
Geriatric, elderly, mental health, developing countries, dementia, depression
Challenges in management of Major Depression in patients with co-morbid medical conditions
Depression is a heterogeneous illness and depression with co-morbid physical illness may represent a phenotype of depression. Concurrent medical illness in depression is associated with greater functional and social impairment and significantly higher health care costs. A variety of mechanisms including lifestyle factors, immune-inflammatory pathways, medications and psychological factors have been proposed to explain the association between depression and physical illness. However, each of these pathways engenders unique challenges in managing such patients. Of utmost importance is to establish the nature of the underlying medical or psychological cause(s) which will inform customized management plans. This article initially reviews the prevalence of depression in medical conditions and vice versa. Subsequently, we move on to discuss specific approaches to diagnosis of depression in the context of medical co-morbidity. Finally, we describe evidence based pharmacological and psychosocial intervention strategies with some recommendations for common clinical scenarios. Evidence based care models to manage depression with physical illness are described which may be adapted for use in low resource settings
Depression, depressive disorder, co-morbidity, psychosomatic medicine; consultation-liaison psychiatry; psychiatry