Background: Expressed emotion (EE) is a strong predictor of outcomes in patients with mental disorders. Effective psychoeducation can improve communication between patients and caregivers. Low levels of EE are associated with better patient outcomes. Objectives: The present study was aimed to assess the effect of psychoeducation on EE among caregivers of patients with mental disorders who were admitted to a tertiary care teaching hospital in Kerala. Methods: A pre-experimental, pre-test, post-test design was used. The sample size was 30, who were family members of patients with serious mental disorders. Expressed emotion family questionnaire (FQ) and sociopersonal data sheet were used. Ethical permission was obtained. Data were subjected descriptive and inferential analysis. Results: The findings show that there was a significant difference (p < 0.01) in the mean score of FQ before and after psychoeducation, as well as the on subdomains scores of critical comments (CCs) (p = 0.001) and emotional overinvolvement (p = 0.001). Conclusion: Expressed emotion in caregivers of patients with mental illness can be improved with effective and scientifically communicated psychoeducation.

Background: Medical students are at higher risk of adverse mental health outcomes, more so in the context of the COVID-19 pandemic. As a result of maladaptive coping mechanisms to stress, they are more likely to develop substance and behavioral addictions. This study was carried out to identify associations between sexual addiction and several psychological determinants, considering the paucity of literature regarding sexual addiction in this population. Materials and methods: Using the snowball sampling technique, an online survey was carried out among undergraduate students at a government medical college. Assessment tools included Young's Internet Addiction Test, Sexual Addiction Screening Test, WHO ASSIST V 3.0, MSPSS, DASS-21, PANAS-GEN, McMaster Family Assessment Device, UCLA Loneliness Scale, Fear of Coronavirus 19 scale. The objectives were to determine the prevalence of sexual addiction in this demographic and to assess its psychological factors. SPSS v27.0 Grad Pack was used to analyze the data. Results: Out of the 106 participants, 21 (19.8%) screened positive for sexual addiction. Sexual addiction was identified to have a significant positive association with internet addiction (p = 0.02), alcohol use (p = 0.00), depression (p = 0.03) and stress (p = 0.03), and a significant negative association with perceived social support from friends (p = 0.02) and family (p = 0.05). Stepwise multiple linear regression found alcohol use, perceived social support of friends and time management and performance domain of internet addiction test (IAT) to predict sexual addiction. Conclusion: The results point to a significant co-occurrence of problematic patterns of substance use and behaviors suggestive of addictions. This highlights that common vulnerabilities may underlie addictions. Knowledge of sexual addiction risk factors will have immense clinical utility be it to identify vulnerable individuals or to plan interventions that target these risk factors while treating sexual addictions.

Background: Stress is an inevitable phenomenon. Medical college environment is a stressful environment due to its exhaustive academic and extracurricular activities. A competency-based medical education (CBME) curriculum was introduced in 2019. Aim: This online study was undertaken at Tezpur Medical College to explore stress among medical students from the CBME curriculum. Materials and methods: The Medical Student Stressor Questionnaire (MSSQ) tool was applied and divided into six domains. Results: A total of 400 students responded to the online study. Out of these, 185 were female and 215 were male. The students comprised a heterogeneous group from different batches ranging from 1st to 7th semesters with the 7th semester comprising the highest (29.5%) and the 1st semester as the lowest (19%). Academic-related stressors (ARS) have been associated with the highest stress (2.19 ± 0.85) and drive and desire-related stressor have the lowest stress (1.33 ± 0.94). The mean scores for males were lower than for females and were statistically significant. Both the overall score and ARS domain scores differ across semesters significantly. Comparable findings have been revealed in this study with studies from pre-CBME curriculum era. Conclusion: Stress management strategies and the provision of a congenial environment in the medical college may help to reduce stress.

Background: Occupational therapy in India has seen substantial growth and diversification in recent years, with an increasing number of educational programs and varied practice settings. Private practice, especially in mental health, presents unique opportunities and challenges for occupational therapists (OTs). Aim: This qualitative study aimed to explore the opportunities for OTs in mental health private practice in India. Methodology: A qualitative phenomenological study design was employed with six OTs practicing in mental health settings in India. Data collection involved telephonic interviews and thematic analysis was employed to analyze the transcribed interviews for identifying patterns and themes. Results: The study identified several opportunities for private practice in mental health OTs in India, including the demand for specialized services, flexibility in service delivery, and the ability to reach underserved populations. Occupational therapists emphasized the importance of collaboration with psychiatrists and other healthcare professionals, engagement in continuous professional development and advocacy to promote their services. Conclusion: Private practice in mental health occupational therapy within India offers substantial potential for OTs to meet the increasing demand for specialized mental health services and adapt their practice to diverse settings. The study highlights the significance of collaboration, ongoing professional development, and advocacy efforts to ensure success in this practice setting, ultimately contributing to bridging gaps in mental healthcare and addressing the unique needs of clients.

Aim: To assess the prevalence and severity of depression in married psoriasis patients and to determine its correlates with special reference to marital adjustment. Materials and methods: A total of 50 patients with a history of psoriasis for more than or equal to 2 years (age range, 26–45 years; mean age, 33.0 ± 5.61 years; 80% males) were enrolled in the study. The prevalence and severity of depression were assessed using the Hamilton depression rating scale (HDRS), and the severity of psoriasis was assessed using the psoriasis area and severity index (PASI). The marital adjustment was assessed using the marital adjustment questionnaire (MAQ). Multivariate linear regression was performed to find out independent factors related to HDRS. Results: Mean HDRS was 10.06 ± 5.25. Mild, moderate, and severe depression was seen in 46%, 18%, and 6% of patients, respectively. On multivariate linear regression, after adjusting for age, sex, place of residence, occupation, socioeconomic status, duration of marriage, number of children, BMI, psoriasis type, and duration of psoriasis, only PASI scores (p = 0.035) and MAQ scores (p < 0.001) emerged as factors independently associated with HDRS score (r² = 0.602). In a reduced linear regression model, both PASI scores and MAQ scores were significantly associated with HDRS (r² = 0.527). Conclusion: Depressive symptoms were common in psoriasis patients and were associated with psoriasis severity (PASI). Marital adjustment offered a protective effect against depressive symptoms.

Background: Numerous neurological soft signs (NSS), which act as a measure of illness severity, are frequently experienced by the susceptible group of people with chronic mental illnesses. An individual's social functioning may be greatly impacted by NSS, with subsequent long-term effects on their mental health and well-being. However, nothing is known about how common NSS are in the Indian context. Materials and methods: In a rehabilitation facility, 95 randomly chosen participants aged between 18 and 60 participated in a cross-sectional study. Using the neurological evaluation scale (NES), NSS were evaluated. Results: The frequency of neurological soft symptoms did not change by gender (p = 0.916), age (p = 0.304), or literacy (p = 0.067), duration of treatment (p = 0.187), marital status (p = 0.134), age of onset of illness (p = 0.685). However, the NSS scores did differ significantly (p = 0.045) according to the length of the illness in one component of the NES scale. Conclusion: The results were different from those of earlier research in other populations, which found lower prevalence rates for NSS. The study stresses the need for more research to completely understand the complex interactions between NSS and chronic mental illnesses, and also the effects of many environmental factors on their comorbidity.

Anticholinergic medicines, such as dicyclomine, are frequently prescribed as antispasmodics. In addition to its effects on the peripheral nervous system, dicyclomine also induces central anticholinergic effects due to its high penetration into the central nervous system. There have been reports of abuse or misuse of anticholinergic medicines, such as procyclidine, biperiden, benztropine, and trihexyphenidyl (Benzhexol). In this case report and review, we describe a case of an adolescent female who came to us with complaints of right lower quadrant abdominal pain, with imaging and other tests ruling out any structural cause for the last 7 years. She even underwent appendectomy 12–16 months before presenting to the hospital with complaints of pain which shifted to the left lower quadrant post appendicectomy. At the time of presentation, she was taking 200 mg of Tramadol and 3–4 tablets of fixed dose combination (FDC) of 250 mg mefenamic acid and 10 mg dicyclomine by a local chemist without any prescription. According to ICD-10, patient met criteria for abuse of non-psychoactive substances with co-morbid mental and behavioral disorders due to the use of opioids-dependence and moderate depression without somatic syndrome. This case illustrates the need to give attention toward the addiction potential of anticholinergics and the need to formulate a treatment plan for effective outcome.

Gambling is a high-risk activity that can be addictive and has both financial and personal repercussions. There is an association between gambling risk and intensive engagement in cryptocurrency trading. The management of gambling disorder has relied on medications including naltrexone and selective serotonin reuptake inhibitors (SSRIs), which have certain limitations including adverse effects and the need for longer treatment, respectively. This case report describes the use of adjunctive endoxifen in a male patient who had overinvested in cryptocurrency. The patient had used his own funds and had borrowed as well as stolen money for this purpose. The patient was counseled and treated with endoxifen, which successfully helped him overcome the habit of cryptocurrency gambling. Endoxifen is a protein kinase C (PKC) inhibitor and PKC overactivity leads to impulsivity. Hence, the use of endoxifen could be an effective strategy in the management of gambling disorders. Larger studies exploring this approach are needed.

Aim and background: This case report explores the potential overlap between autism spectrum disorder (ASD) and moyamoya angiopathy (MMA). While the association between ASD and ischemic stroke is established, the link to MMA remains unclear. This case highlights the importance of recognizing ischemic stroke, particularly MMA, as a possible comorbidity of ASD. Case description: A 6-year-old girl presented at the Psychiatry Outpatient Department (OPD) with complaints of behavioral and communication disturbances with a prior history of MMA and revascularization surgery. Following school enrolment, her symptoms worsened, including increased irritability, temper tantrums, and self-injurious behaviors. A comprehensive evaluation confirmed ASD and led to adjustments in her medication regimen. Consent was obtained from the parents for the publication of the case. Conclusion: This case suggests a potential link between ASD and MMA. Early detection and intervention for both conditions are crucial for improved outcomes. Clinical significance: This case emphasizes the need for healthcare professionals to consider ischemic stroke, especially MMA, in the evaluation of ASD.

Background: Dysthymia, characterized by persistent low mood without reaching the severity of depression, poses a challenge in terms of prolonged symptom duration and limited response to conventional antidepressant therapies. Case description: This case report details the presentation of a patient with dysthymia inadequately responding to antidepressant treatments. Intravenous ketamine was given as an adjunctive treatment, resulting in significant clinical improvement. Conclusion and clinical significance: Our findings suggest that ketamine could serve as a beneficial adjunct in the treatment of dysthymia. However, it is noteworthy that sustained efficacy may necessitate frequent infusions, ideally at intervals of at least 2 weeks. Further research is warranted to validate and expand upon these observations, offering new insights into the potential role of ketamine in the management of dysthymia.

Possession may happen under acute stress and is more common in people who are religious and those believe in God. The disorder also happens when someone believes in black magic and feels that someone has cast a spell or done this to him or her. It can also happen as a part of a delusion when one feels that one has been possessed by a witch or evil spirit and the same is a part of a delusional system as seen in schizophrenia. Hereby we present a case of possession seen in one member of the family which later led to other family members getting affected.

Tardive dyskinesia is a movement disorder that causes involuntary, repetitive body movements and is commonly seen in patients who are on long-term treatment with antipsychotic medications. It occurs in 20–50% of patients taking APDs. Akathisia is a neuropsychiatric syndrome characterized by subjective and objective psychomotor restlessness whose severity can extend to self-harm and suicide. Case description: Our index case, a 57 years old, Hindu married female, of lower socio-economic status, diagnosed as a case of schizophrenia for 2 years, and well maintained on Tab. Amisulpride 600 mg daily, came in July 2022, with complaints of pain and upper abdominal discomfort and distension of abdomen for which she was prescribed Levosulpiride 50 mg daily. On next visit, in October 2022, she was having dyskinetic movements of the lips and rhythmic protrusion of the tongue, along with rhythmic movement of the whole abdomen. Eventually, she was diagnosed as a case of Levosulpiride-induced Tardive Dyskinesia and Levosulpiride was stopped. Tetrabenazine 50 mg daily was started. Subsequently, she became very restless and complained of uneasiness of whole body. Due to severe uneasiness and restlessness, she attempted suicide three times in presence of her family members and thus was prevented. In March 2023, she was having dyskinetic movement of oral cavity and rhythmic involuntary movement of the abdomen and was restless and irritable. She was continuing Amisulpride 600 mg and Tetrabenazine 50 mg daily. But unfortunately, there was no symptomatic improvement. NARANJO assessment score was applied which showed probable drug reaction. Then, it was diagnosed as a case of Amisulpride-induced Tardive Dyskinesia with Akathisia. Amisulpride was also stopped and no antipsychotics were given. For Akathisia, Lorazepam 4 mg in divided doses and Propranolol 40 mg was added to Tetrabenazine 75 mg daily. Now, patient started improving, having no fresh complaints although presently not on antipsychotics.

Introduction: Bipolar disorder is a widespread psychiatric condition characterized by mood swings, impacting millions worldwide. It includes subtypes such as bipolar I and bipolar II, with differing manic and depressive episode patterns. Treatment encompasses medication, psychotherapy, and psychosocial interventions. Managing antidepressant use in bipolar disorder is crucial due to the risk of the treatment-emergent affective switch (TEAS), where antidepressants can induce shifts from depression to mania or hypomania, a complex phenomenon influenced by genetics, neurobiology, and environment. Atypical antipsychotics offer promise as mood stabilizers and TEAS risk reducers. Patient factors such as age, gender, and illness history also influence TEAS susceptibility. Recognizing and addressing TEAS is vital in clinical practice to prevent symptom exacerbation and functional impairment. In this case series, we delve into TEAS among bipolar patients receiving antidepressant treatment, aiming to deepen comprehension, enhance patient care, and inform future research. Methods: This study includes nine cases obtained from a tertiary care center, with a focus on six selected cases diagnosed with bipolar affective disorder and TEAS as per the International Classification of Diseases, Tenth Revision (ICD-10) criteria. Case selection involved extensive interviews, data collection from hospital records, and discussions with treating psychiatrists. Consent was obtained and privacy was maintained. Demographic, social, and clinical information is presented, offering a comprehensive overview of the cases. These data provide insights into the occurrence and management of TEAS in bipolar affective disorder. Detailed case information can be found in the tables.