Background: Exponential use of internet has resulted in internet addiction in recent times. Students are particularly at risk because of their unique personal, social, and academic needs. Objectives: The study was designed to evaluate the prevalence of internet addiction and its determinants among medical students. Materials and Methods: A cross-sectional study was conducted in 282 medical students with the help of semi-structured questionnaire consisting of questions related to demographic information, information related to internet use, and Young's internet addiction test. Results: We found prevalence of internet addiction among medical students to be 58.87% (mild – 51.42%, moderate –7.45%) and significantly associated factors with internet addiction being male gender, staying in private accommodation, lesser age of first internet use, using mobile for internet access, higher expenditure on internet, staying online for longer time, and using internet for social networking, online videos, and watching website with sexual content. Conclusion: Medical students are vulnerable for internet addiction and efforts should be taken to increase awareness and prevent the problem of internet addiction in them.

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Introduction: Type 2 diabetes mellitus is a significant health problem and imposes great physical, financial and psychological burden among the affected population. Among people with diabetes, fatigue is a pervasive and distressing complaint, which is further accentuated by presence of depression. Objective: To assess the prevalence of fatigue and depression and associated clinical and socio demographic correlates in type 2diabetes. Materials and Methods: This cross sectional study included 100 patients of diabetes type 2 and equal number of healthy controls between the ages of 18 to 70 years . A detailed evaluation of socio demographic and clinical parameters was made. Participants were also assessed for presence of depression and fatigue using PHQ-9 and Fatigue Severity Scale(FSS)respectively. Results: Fatigue and depression was found in 68 % and 53 % of diabetic participants. Diabetic patients were 10.37 times and 4.80 times more likely to suffer from fatigue and depression respectively. Both fatigue and depression were found to be significantly associated with duration of illness, fasting and post prandial blood glucose level ,diabetic complications and Body Mass Index (BMI). Fatigue was also strongly correlated with depression in study sample. Conclusions: Fatigue and depression are reasonably correlated with type 2 diabetes. Various clinical parameters of diabetes are strongly associated with both fatigue and depression. Fatigue itself has significant correlation with depression in type 2 diabetes. Regular monitoring of biochemical parameters are paramount to predict the development of fatigue and depression in type 2 diabetes.

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Counterproductive work behavior (CWB) has long been recognized as a broad spectrum of job behaviors and its link with negative affectivity and hostile behaviors. It is a major concern practically for all organizations. Repeated exposure to workplace stressor can result in a strain, an outcome of the job stress process that can be psychological, physical, or behavioral in nature, leading to CWBs. Yoga is a technique that brings an improvement on mental and physical level by means of posture, breathing control methods, and silencing the mind through meditation. Though yoga has received less scientific consideration, there has been a significant growth in the study of yoga in the healthy population. Mindfulness and self-control practices like yoga encourage individuals to be aware and accept their aggression linked thoughts and emotions simply as a short-lived state rather than to control them. The positive effects of yoga on the improvement of personality traits are already proven. This paper introduces a simple model of cost-effective, trials of yoga intervention at the workplace which could result in the twin benefits of substantial savings from losses for the employers by reducing the CWB and health improvements for the employees by reducing the negative affectivity and aggression. Internet databases such as PubMed, Google Scholar, and APA PsycNET were accessed. The available data were systematically reviewed in a structured manner and analyzed.

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Context: There is scant research on premenstrual syndrome (PMS) and its more severe counterpart, premenstrual dysphoric disorder (PMDD) in Indian females. This study aimed to evaluate symptoms of PMS in medical students and to find the association of sociodemographic variables and lifestyle factors with PMDD. Subjects and Methods: A total of 179 medical students residing in the hostel of an Indian medical college and its affiliated teaching hospital were approached, of which 100 (55.8%) returned the completed questionnaires. Data related to lifestyle factors was collected. Self-screening quiz for Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision PMDD and Shortened Premenstrual Assessment Form were used for diagnosis of PMDD and detection of symptomatology, respectively. Results: PMDD was present in 37% of the respondents. It was found at a higher rate in older and postgraduate students. PMDD was significantly associated with lifestyle factors, namely, sleep, physical activity, total tea/coffee intake, and change in tea/coffee and food intake under stress. The most common physical and psychological symptoms were body ache/joint pain and feeling depressed/blue, respectively. Conclusions: PMDD is fairly common in Indian medical students residing in hostel although cultural factors may influence symptom expression. This study suggests that PMDD is associated with lifestyle factors in young, professional, urban women. Modification in lifestyle may thus be an important approach for management of PMS/PMDD. Prospective studies with larger representative samples are needed to validate these findings.

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Background: Alopecia areata (AA) and psoriasis are associated with various psychiatric comorbidities. Both greatly affect the quality of life (QOL) of patients and psychiatric comorbidities can further worsen it. Thus there is need to recognise psychiatric comorbidities and treat them in these patients. Aims: To determine the psychiatric morbidity and the QOL in these patients to study the factors affecting them. Methodology: 50 patients each of psoriasis and AA were included. 50 people accompanying these patients served as control group. They were diagnosed for psychiatric disorders by clinical interview. Scales used were severity of alopecia tool for AA, psoriasis area and severity index for psoriasis, WHO-QOL scale, Hamilton Rating Scale for anxiety and depression. Results: 22% and 38% patients in AA and psoriasis group respectively suffered from psychiatric disorder, depression was present in 18% and 24% of patients and 4% and 12% had anxiety disorders in respective groups. The control group had only 6% of psychiatric comorbidities. QOL scores had negative correlation with Hamilton-A, Hamilton-D and severity of psoriasis scores and they were statistically significant but not with severity of AA. Conclusion: Thus AA and psoriasis patients had more prevalence of psychiatric comorbidities and it had bearing on their QOL.

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Objectives: To explore the quality of life (QOL) and its association with psycho-sociodemographic factors among caregivers of mentally ill patients in a tertiary care hospital in urban India. Materials and Methods: Sample consisted of 100 caregivers attending outpatient services in a tertiary care hospital. Data was collected using World Health Organization QOL-BREF (WHOQOL-BREF) questionnaire. The higher score meant a better QOL. Results: Of 100 caregivers, 66% were men, 47% were parents and 64% were literate. 52% of the caregivers were providing care for 1–5 years. The mean total score of QOL of the study population was 13.34 with the highest score 15.15 in the physical domain, followed by 12.75 in social, 12.96 in environmental, and 12.52 in psychological domain. In a multiple linear regression model, caregiver's elderly age was significantly associated most of the domains of WHOQOL. Conclusion: Caregivers of mentally ill patients have diminished QOL levels. Studies measuring QOL among caregivers can help initiate early intervention among the vulnerable caregivers. This study would help in increasing the awareness among the professional health care workers, to identify at risk caregivers. Health workers by providing better health services and better psycho-education to the caregivers can improve their QOL.

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Background: Adolescent suicide is an important public health issue. Suicidal ideations are often the precursor of suicide and can be targeted by appropriate and timely interventions. Aims and Objectives: To determine the prevalence of suicide ideation and to study its predictive factors among school going adolescents. Materials and Methods: This cross-sectional study was carried out in selected senior secondary schools in Shimla district of Himachal Pradesh, India. A pre-validated, self-administered questionnaire was used for data collection. Both descriptive and inferential statistics were applied using Epi info software for windows (CDC Atlanta) software for windows. Results: A total of 218 study subjects (30.9%; confidence interval = 27.6–34.5%) had suicide ideation. Discussing problems with parents (adjusted odds ratio [AOR] =0.5), having good relations with school teachers (AOR = 0.6) and helpful classmates (AOR = 0.6) lowered the odds of having suicidal ideations. On the contrary, adolescents having worrying issues in family (AOR = 2.5), verbally or physically abused (AOR = 2.8) and body image conscious (AOR = 1.8) had increased odds of suicidal ideations. Conclusions: Suicidal ideation is a common experience among adolescents residing in Shimla district of North India. The supportive environment at home and in school decrease its vulnerability.

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Aim: To explore relation between cognitive self-regulation, social functioning, and psychopathology in schizophrenia. Materials and Methods: A total of 100 patients diagnosed with schizophrenia according to International Classification of Diseases (ICD)-10 were taken from Department of Psychiatry of two postgraduate hospitals of Kolkata, India. All subjects gave informed consent. After recording sociodemographic and clinical details, the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), Schizophrenia Research Foundation India-Social Functioning Index (SCARF-SFI), and specially designed questionnaire on cognitive self-regulation was administered. Results: All the four subtests of SCARF-SFI, that is, self-concern, occupational role, social role and family role, and symptoms scale of PANSS were significantly correlated with cognitive self-regulation. Cognitive self-regulation along with positive and negative symptoms was able to predict social functioning. Conclusion: Cognitive self-regulation is significantly and positively correlated to social functioning. Cognitive self-regulation along with positive and negative symptoms is a significant predictor of social functioning.

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Background: A lot of stigma and misconceptions about pulmonary tuberculosis still persist, in spite of the advances in treatment. Thus, a mere diagnosis of pulmonary tuberculosis can be a psychological trauma to an individual. The situation has aggravated with the association of tuberculosis with HIV infection. Aim: To study the psychiatric morbidity due to the various psychological stresses faced by a patient of pulmonary tuberculosis. Materials and Methods: The study group consisted of 100 inpatients admitted to pulmonary ward with diagnosis of pulmonary tuberculosis. The control group consisted of 100 inpatients admitted to pulmonary ward with nontuberculous pulmonary diseases. Psychiatric history and mental status were recorded on a specially designed proforma and diagnosis of any psychiatric illness, if present, arrived at as per International Classification of Diseases (ICD-10). The psychiatric tests applied were beck's depression inventory (BDI) and Taylor's Manifest Anxiety Scale (TMAS). Results: Of the patients of pulmonary tuberculosis, 24% could be given a diagnostic category, as per ICD-10, as compared to only 8% of the controls (P < 0.005). On BDI, 44% of patients of pulmonary tuberculosis showed depression as compared to 27% of the controls (P < 0.02). On TMAS, 38% of patients of pulmonary tuberculosis showed anxiety as compared to 24% of controls (P < 0.05). A greater incidence of depression (on BDI) and anxiety (on TMAS) was seen in those with longer duration of illness (P < 0.02) and in those with greater severity of illness (P < 0.02). Conclusion: In view of the high psychiatric morbidity associated with pulmonary tuberculosis, there is enough scope for psychiatric services to be made available to these patients. In addition, personnel involved in the treatment of these patients should be trained for early detection of psychiatric symptoms.

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Objectives: This study assessed intimate partner violence (IPV) and alcohol use in an urban population in Pune, India. The prevalence of IPV and alcohol use was assessed along with the correlation of IPV with alcohol and other variables. Materials and Methods: The study was cross-sectional, questionnaire-based. The materials used were the hurt insult threaten scream (HITS) scale, the alcohol use disorders identification test, and a brief psychosocial questionnaire. Systematic random sampling was done on the target population. Regression analysis of various factors in relation to HITS score was done. Results: Sample size (n) was 318 individuals. Prevalence of IPV was found to be 16% and the victims were mostly women. Prevalence of alcohol use was 44%, of which 8.9% were harmful users. No female subjects consumed alcohol, but 94% were aware of their husband's alcohol consumption. No significant correlation was found between IPV and education (P = 0.220) or income of women (P = 0.250). Alcohol consumption by males was a significant risk factor for women experiencing IPV (σ = +0.524; P< 0.001). Regression analysis also revealed that increasing marital age (P = 0.019) and financial support from in-laws (P = 0.040) were significantly protective. Conclusion: IPV prevalence was less than the national average for India, but the majority of victims was women. The most common type of IPV was verbal. Alcohol use prevalence was higher than the national average, but harmful use was lower. Alcohol use is a significant risk factor for IPV. Education and income of women were not significantly protective against IPV but increased age at marriage and support from in-laws were.

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Background: Depression is the most common mental health problem across all the age groups. Still diagnostic techniques and laboratory tests are awaited to confirm it. Some studies focus on P300 latency to aid in the diagnosis of depression. Hence, this study was conducted to know whether P300 latency is an indicator of major depressive disorder (MDD). Methods: This study was conducted both on patients admitted in the hospital and those attending outdoor clinic giving written informed consent and fulfilling inclusion/exclusion criteria from the Department of Psychiatry, S.N. Medical College and Hospital, Agra. The sample consisted of 30 consecutive patients suffering from MDD as per the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and 30 subjects as normal control. Sociodemographic and clinical history proforma, Hamilton Rating Scale for Depression (Ham-D), and P300 were administered on all 60 subjects. Data were analyzed using mean, standard deviation, and t-test. Results: Significant difference (P < 0.0001) has been found in HAM-D mean scores of depressed and nondepressed control group subjects. The mean score of depressed group was significantly high (18.066) compared to nondepressed control group (4.833). Significant difference (P < 0.0001) between the mean of P300 latency in depressed and nondepressed control subjects was also found. Mean score of P300 latency in depressed group was significantly high (346.918 ± 19.515) compared to the nondepressed control subjects (303.741 ± 6.378). There was a significant difference in the mean of P300 latency between mild and severe (P < 0.0001), mild and very severe (P < 0.0003), as well as moderate and severe (P < 0.0001) level of depression. Conclusions: P300 latency may be used as an indicator of MDD and it is directly proportional to the severity of MDD.

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There is a lot of diversity in the medical realm; where unspecified sign and symptoms might confuse and force even experienced clinicians to commit mistakes. Paper eating is presently included in pica, but certain rare compulsions may mimic this and cause confusion for unsuspecting observers. We report a case of paper eating as a manifestation of compulsion in a 15-year-old girl, and reiterate that missing on rare presentations might cause the patient sufferings from inadvertent pharmacological treatment efforts.

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Context: Alcohol use contributes to considerable morbidity and mortality worldwide. Screening for alcohol use and alcohol use disorder (AUD) at the primary care level can help in reducing this burden. While several community studies have been conducted to estimate the AUD, there apparently are no studies on opportunistic screening in a primary care setting in India. Aims: The aim was to estimate the prevalence of alcohol use and AUD in a primary care setting. Settings and Design: A hospital-based cross-sectional study was conducted among adult male outpatients in a primary care setting in Puducherry, South India. Subjects and Methods: Male outpatients aged 18 and above were interviewed for alcohol use. Current alcohol users were screened for AUD using World Health Organization - AUD identification test (AUDIT) questionnaire, respectively. Statistical Analysis Used: Proportions were used to describe the study population and the main study findings. The Chi-square test was used to find out the association between sociodemographic factors and alcohol use. Results: Of 256 subjects studied, 39.8% were found to be current alcohol users and 10.9% had AUD (AUDIT score ≥8). The sociodemographic factors did not show any association with an alcohol use in the current setting. Conclusion: Based on the findings of the present study, four current alcohol users are to be screened to identify one patient with AUD. Screening at the primary health care level can help in identifying the risk group and thus help in reducing the morbidity and mortality due to alcohol use in the population.

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Osmotic Demyelination Syndrome includes Central Pontine Myelinolysis and Extrapontine Myelinolysis. This condition has been described in cases of chronic Alcohol Dependence Syndrome and in rapid correction of hyponatremia. Though we frequently see patients with Alcohol Dependence Syndrome presenting with complicated withdrawal, Central Pontine Myelinolysis remains largely undetected and under-reported in literature. We present here a case of protracted Delirium Tremens where MRI brain revealed Central Pontine Myelinolysis. Subsequently cognitive assessment revealed significant dysfunction and brain SPECT showed hypo-perfusion of the frontal lobes. Osmotic Demyelination Syndrome should be suspected in protracted Delirium Tremens.

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Background: Substance misuse is an increasing problem in urban and rural India. The utility of community-based interventions and preventive strategies are increasingly emphasized in this context. The drug de-addiction and treatment center, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, has been running a drug de-addiction and treatment clinic at Kharar Civil Hospital, Kharar, District Mohali, Punjab, since 1998. As part of an effort to enhance this community outreach program, community-based drug awareness and treatment camps have been organized since March 2004 in villages in and around Tehsil Kharar of Mohali. Aim: To study the impact of the drug awareness and treatment camps on the attendance of patients at the community outreach drug de-addiction and treatment clinic at Kharar Civil Hospital. Methods: Sociodemographic and clinical variables, including treatment outcome-related variables, of patients attending the clinic at Kharar Civil Hospital, before and after the camps were compared. Discussion and Conclusion: The study showed a positive impact on drug awareness and treatment camps held in the community on outpatient attendance at a community outreach clinic, with attendance increasing more than 1.8 times.

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Gilles de la Tourette's syndrome is an uncommon illness associated with repetitive un-voluntary abnormal movements and utterance. It is often associated with other psychiatric morbidities. Management requires awareness of this uncommon illness, keen observation, relevant evaluation, and combination of pharmacology and psychotherapy for an optimal outcome. This case is brought out here for florid presentation and nuances of management.

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Background: Suicides, attempted suicides and different form of suicidal behaviors are on the rise in most part of the world. It is generally assumed that official suicidal rate are underestimated from the true rate by 20-100 % due to prevailing socio-cultural issues, religious attitude, stigma attached, and legal process involved. Attempted suicides occur 8-20 times more frequently than complete suicide. Statistics on attempted suicide or deliberate self harm are not usually available officially. Materials and Methods: All the cases of attempted suicide who were admitted and referred for psychiatric evaluation and management to a rural medical college of central India during a period of one Year (April 13-March-14), following initial recovery they were evaluated on a semi-structured performa on socio demographic profile, mode of attempt and reason for attempt. Data collected was analyzed using suitable statistical methods. Results: Total 68 cases were evaluated during the study period. 43% of the cases were involved in farming. Among 85% of the study population pesticide consumption was the common mode of attempt, which is easily available among the agrarian community of rural India. Interpersonal conflict in the family due to indebtedness, financial loss due to crop failure was the commonest reason for attempt. Conclusion: Though there is reduced reporting in the incidents of suicide cases in media from this region, still quite a number of people attempt suicide due to financial constraint from crop failure, ongoing indebtedness, and poor socioeconomic condition culminating into poor mental health among the rural agrarian community of central Maharashtra.

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There is limited literature on the use of electroconvulsive therapy (ECT) in patients with recent myocardial infarction and in those with reduced cardiac output. In this report, we describe the safe use of ECT in a 70-year-male suffering from severe depressive episode with psychotic symptoms. He had a history of poor response to adequate pharmacotherapy and had suffered from myocardial infraction (MI), about 3 weeks prior to admission to the psychiatric unit. In view of severe depression associated with marked anxiety, agitation, psychotic symptoms, and poor food intake he was started on ECT after 5 weeks of MI when his cardiac output was only 30%. He received nine sessions of ECT without any cardiac complications and his depression remitted with ECT.

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Introduction: Possibility of cognitive side effects has made electroconvulsive therapy (ECT) questionable. Variable deficits have been debated in memory cognition. Pattern of changes in nonmemory cognition pre- and post-ECT is not clear. Methodology: Forty patients undergoing ECT were studied on nonmemory cognitive parameters before ECT, after a course of ECT, and after 4 weeks of last. ECT. Results: Nonmemory cognition improved during the course of ECT and over 4 weeks of ECT. Conclusions: ECT does not affect the nonmemory cognition adversely.

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