ABSTRACT Objectives: Persistent Postural Perceptual Dizziness (PPPD) is a recently classified functional vestibular disorder characterized by chronic dizziness and imbalance, often associated with anxiety and visual motion sensitivity.Objective of the study is to use the Dizziness Handicap Inventory (DHI) to assess the impact of PPPD on physical, emotional and functional domains. Materials and Methods: This prospective study was conducted at a tertiary Hospital in South India over one year. Eighty-seven adults (21–60 years) diagnosed with PPPD as per Bárány Society criteria were included. Baseline evaluation included clinical, neurological, and psychiatric assessments along with audiological tests to exclude other causes. Patients completed the DHI questionnaire before treatment initiation. All were managed with Duloxetine (20 mg/day), Propranolol (40 mg/day), Cognitive Behavioral Therapy (CBT), and vestibular rehabilitation exercises for 12 weeks. Post-treatment DHI scores were recorded. Data were analyzed using paired t-test with significance at P < 0.05. Results: Of 300 screened patients with dizziness, 87 (29%) had PPPD (Male:Female = 55:32). Mean baseline DHI was 52.74, which improved to 26.30 after treatment (50.13% reduction; P < 0.05). Physical domain showed the highest improvement (62.44%), followed by emotional (47.32%) and functional (43.13%) components. No major adverse effects or dropouts were reported. Discussion: Multimodal management, including pharmacotherapy and CBT, resulted in significant improvement across all DHI domains, with physical symptoms responding best. Functional limitations were the least improved, suggesting the need for prolonged therapy. Conclusion: DHI is a useful tool to quantify disability in PPPD. Combined pharmacological and behavioral interventions significantly improve quality of life in affected patients.
ABSTRACT Context: Perinatal depression is a widespread mental health concern affecting women during pregnancy and postpartum, with significant consequences for both mother and child. Early detection through reliable screening tools is essential, especially in resource-limited settings. Materials and Methods: This cross-sectional study was conducted at a government teaching hospital in Telangana, India, involving 122 perinatal women aged 21–45 years in their third trimester or postpartum period. The Telugu version of the World Health Organization 20-item Self-Reporting Questionnaire (SRQ-20) was translated, standardized (Cronbach’s alpha = 0.964), and administered to assess the prevalence of depression and common mental disorders (CMDs). Sociodemographic and obstetric data were also collected, and statistical analyses included t-tests, analysis of variance, and Chi-square tests to explore associations. Results: The SRQ-20 demonstrated high internal consistency. Most participants (79.3%) exhibited mild symptoms, with smaller proportions showing moderate (13.3%) and severe (7.4%) levels of depression or CMD. No significant differences in SRQ scores were found across most sociodemographic variables, except for family income and husband’s occupation, which showed significant associations with SRQ-20 scores. Conclusion: The Telugu version of SRQ-20 is a reliable and practical screening instrument for identifying perinatal women at risk of depression and CMD in clinical settings. Routine screening using this tool can facilitate early detection and referral for appropriate mental health interventions, ultimately improving maternal and infant outcomes.
ABSTRACT Background: Psychiatric disorders are a major health concern worldwide, with significant biopsychosocial consequences. In India, the prevalence of psychiatric illnesses is estimated at 13.9%, with depression and anxiety disorders being among the most prevalent. A notable clinical overlap exists between psychiatric conditions and cardiovascular symptoms, particularly in patients presenting with medically unexplained chest pain, which may mimic coronary artery disease (CAD). This study aims to explore the sociodemographic characteristics, medical comorbidities, and psychosocial stressors in patients with psychogenic chest pain syndrome (PCS) at a tertiary cardiology department and to assess the importance of incorporating psychiatric assessments into routine cardiac care. Methodology: This cross-sectional study was conducted at a tertiary care hospital in South India. A total of 420 participants were recruited, consisting of two groups: 210 patients diagnosed with acute coronary syndrome (ACS) based on positive cardiological tests (control group) and 210 patients presenting with symptoms mimicking ACS but diagnosed with psychiatric disorders (study group). Psychiatric evaluations were conducted using the Mini International Neuropsychiatric Interview and the Patient Health Questionnaire-9, along with other diagnostic tools. Cardiac evaluations included electrocardiogram, troponin-I testing, echocardiography, and coronary angiography. Results: The mean age of the PCS group was significantly lower (42.2 ± 9.6 years) than that of the CAD group (51.4 ± 6.8 years). Gender distribution differed significantly, with the PCS group having an equal male-to-female ratio, while the CAD group had a male predominance. Diabetes and hypertension (HTN) were more prevalent in the CAD group, while hypothyroidism was more common in the PCS group. Depression (38.8%) was the most prevalent psychiatric disorder in the PCS group, followed by various anxiety disorders. Logistic regression analysis revealed that diabetes significantly increased the odds of CAD, whereas hypothyroidism was inversely associated with CAD. Conclusion: This study underscores the significant overlap between psychiatric disorders and ACS, highlighting the need for multidisciplinary evaluations in patients presenting with chest pain. Depression and anxiety disorders were common in the PCS group, while traditional cardiovascular risk factors such as diabetes and HTN predominated in the CAD group. The integration of psychiatric assessments into routine cardiology care is crucial to ensure accurate diagnosis, prevent unnecessary investigations, and improve patient outcomes.
ABSTRACT Background: Mental health disorders are a significant public health challenge, particularly in rural areas where barriers such as geographical remoteness, stigma, and limited infrastructure hinder access to psychiatric care. Aim: To assess profile of referrals, psychometric and psychotherapeutic services provided by the Psychiatry department in a Rural Medical College. Materials and Methods: This retrospective observational study analyzed data from October 2022 to September 2023, focusing on patients who sought mental health services at the Psychiatry Department of a Rural Medical College. Historical data were reviewed, organized, and cleaned, and patients referred to clinical psychologist by psychiatrists, based on various referral sources recorded in the Psychiatry Department and attended at least one psychometric/ psychotherapeutic intervention session were included. Results: The mean age of participants was 28.11 years, with a male predominance (59.87%). Neurotic, stress-related, and somatoform disorders were the most common diagnoses (44.75%), followed by mood disorders (17.59%), substance use disorders (11.11%), and intellectual disabilities (10.49%). A significant proportion (66.36%) had no prior psychiatric treatment. Self-referrals (56.79%) were predominant, followed by referrals from Medicine (23.14%) and Pediatrics (12.04%). Psychometric, such as the Binet-Kamat Test of Intelligence and Vineland Social Maturity Scale (19.35% each), were frequently used. Individual counseling (55.08%) was the most utilized therapeutic service, followed by family counseling (19.16%) and Jacobson’s Progressive Muscle Relaxation Therapy (5.38%). Socio-demographic factors significantly influenced psychometric assessments and psychotherapeutic interventions ( P < 0.05). Conclusion: Strengthening follow-up systems and integrating mental health screening within primary care are crucial to enhance service utilization and improve outcomes in underserved rural communities.
ABSTRACT Mirrored-self misidentification, or mirror misidentification syndrome, is a rare but distressing delusional misidentification syndrome (DMS) observed in neurodegenerative conditions, particularly in patients with right hemisphere dysfunction. It can significantly impair caregiver relationships and worsen patient distress. We report a case of a 72-year-old man with mixed dementia who presented with progressive memory loss, followed by gradual-onset mirror misidentification delusions. He developed a delusion of infidelity toward his wife after failing to recognize his mirror image, believing that another man was being cared for preferentially. His condition worsened with a trial of low-dose risperidone due to severe extrapyramidal symptoms. Subsequent treatment with pimavanserin, lemborexant, and memantine, alongside nonpharmacological strategies, resulted in gradual improvement in delusional thinking and stabilization of cognitive symptoms. This case highlights the diagnostic and therapeutic complexity of DMS in dementia. Recognition of mirror misidentification and tailored management – including nondopaminergic antipsychotics and environmental adjustments – can reduce distress and improve outcomes.
Introduction: Epilepsy contributes to a significant psychosocial and mental health burden in rural populations, where stigma, limited awareness, and poor access to care impede early recognition and support for comorbid anxiety and depression, adversely affecting quality of life and treatment adherence. Materials and Methods: A community-based quantitative cross-sectional study was conducted among 100 adults (18–65 years) with clinically confirmed epilepsy, identified from Primary Health Centre records in rural South India. Anxiety and depression symptoms were screened using the Hospital Anxiety and Depression Scale, and quality of life was assessed using Quality of Life in Epilepsy Inventory-31 (QOLIE-31). Perceived barriers to care were evaluated using structured interviewer-administered questionnaires. Associations were analyzed using Chi-square or Fisher’s exact test, with significance set at P < 0.05. Results: Seventy-two percent and 74% of participants screened positive for anxiety and depression, respectively. Psychological distress showed a significant association with longer epilepsy duration (P = 0.067), poor treatment adherence (P = 0.016), and perceived stigma (P = 0.001). Seizure type was not significantly associated with mental health outcomes (P = 0.142). QOLIE-31 scores revealed marked impairment in emotional well-being and social functioning among screen-positive participants. Conclusion: Rural adults with epilepsy experience high levels of screen-positive anxiety and depression symptoms, driven by modifiable barriers including stigma and economic challenges. Routine mental health screening and integrated rural epilepsy care models are essential, while interpreting results as screen-positive symptoms rather than clinical diagnoses.
The protein kinase-C (PKC) plays an important role in the pathophysiology of mood disorders. Hence, inhibiting PKC with endoxifen is a useful strategy for bipolar disorders. We are describing our experience with endoxifen prescribed to two patients with secondary mood disorder who were either nonresponsive or not tolerating conventional pharmacotherapies and were prescribed endoxifen. Both showed improvement in mood symptoms and functional outcomes over 2 weeks. No significant adverse events occurred. Based on our experience, endoxifen may hold promise in secondary mood disorders. Further randomized studies with a larger sample size are required to confirm our findings.
Background: Recurrent depressive disorder (RDD) is characterized by repeated depressive episodes with significant functional impairment and relapse risk. Psychological variables such as perceived stress, stressful life events, and personality traits are increasingly recognized as important determinants influencing the onset, recurrence, and severity of depressive episodes. Aim: To assess the role of psychological variables in RDD and their association with the severity of depressive episodes. Materials and Methods: A hospital-based, cross-sectional study was conducted among 80 patients diagnosed with RDD. Sociodemographic and clinical data were collected using a semi-structured pro forma. Psychological variables were assessed using the Perceived Stress Scale, Holmes-Rahe Life Stress Inventory, and NEO Five-Factor Inventory, while depressive severity was evaluated using the Montgomery-Åsberg Depression Rating Scale (MADRS). Statistical analysis was performed using descriptive statistics, Chi-square test, ANOVA, and correlation analysis with significance set at P < 0.05. Results: The majority of the participants experienced moderate perceived stress, which was significantly associated with moderate depressive severity. High perceived stress and greater life event burden were associated with increased MADRS scores and a higher proportion of severe depressive episodes. Maladaptive personality traits, including gloomy pessimism, maladaptive defense patterns, temperamental anger, and poor impulse control, were significantly associated with greater depressive severity. Psychological variables collectively demonstrated a significant association with depressive episode severity. Conclusion: Psychological variables play a crucial role in determining depressive episode severity in RDD. Assessment and management of stress perception, life events, and maladaptive personality traits are essential for improving treatment outcomes and reducing recurrence risk.
Acute behavioral disturbances in pregnancy are often attributed to primary psychiatric disorders; however, metabolic causes may present with neuropsychiatric symptoms and remain underrecognized. We present a case report of probable nonhepatic hyperammonemia (NHHA) manifesting as acute psychiatric deterioration with evolving encephalopathy in pregnancy. A 22-week pregnant woman presented with a 4-day history of irritability, decreased need for sleep, increased goal-directed activity, psychomotor agitation, disorganized behavior, muttering to self, screaming episodes, reduced oral intake, and referential ideas, initially suggestive of acute mania with psychotic symptoms. Subsequently, she developed fluctuating attention, disorientation, and impaired recent memory, raising suspicion of an organic etiology. Investigations revealed elevated plasma ammonia (111 μmol/L) with normal liver function tests, along with moderate anemia, gestational diabetes mellitus, and asymptomatic bacteriuria. Magnetic resonance imaging of the brain was normal, while electroencephalography showed diffuse generalized slowing consistent with metabolic encephalopathy. Management included lactulose therapy, antibiotics, anemia correction, metabolic stabilization, dietary modification, and short-term low-dose haloperidol for severe agitation, a commonly used option with relative reproductive safety when clinically indicated. Clinical improvement paralleled a reduction in ammonia levels from 111 to 14 μmol/L. In the absence of confirmatory metabolic investigations, the diagnosis was considered probable NHHA with possible underlying metabolic vulnerability. This case highlights the importance of distinguishing metabolic encephalopathy from primary psychiatric disorders in perinatal settings. Hyperammonemia should be considered in atypical neuropsychiatric presentations, particularly when fluctuating cognition and disorientation are present. Early recognition and timely multidisciplinary management may prevent morbidity and improve maternal outcomes.
Selective serotonin reuptake inhibitors (SSRIs), including escitalopram, are primarily associated with serotonin syndrome; however, rare cases of neuroleptic malignant syndrome (NMS) have also been reported. The proposed mechanism involves serotonergic modulation of dopaminergic pathways, resulting in a functional hypodopaminergic state that may contribute to NMS-like manifestations. In addition, SSRIs may produce extrapyramidal symptoms such as rigidity, tremors, and dystonia through serotonin-mediated inhibition of dopaminergic neurotransmission. In this case, we present a 73-year-old male patient who has been brought to the outpatient department with the chief complaints of fever, difficulty in swallowing, and rigidity of all four limbs. According to the family members, the patient was on escitalopram 20 mg and lithium 450 mg twice daily; he is not on any other medication for last 4 years. The patient has a history suggestive of bipolar depression for 14 years. Both lithium and escitalopram were stopped 4 days before consulting at our hospital, as he went into an altered sensorium. The patient was admitted as he was in an altered sensorium with high fever, having difficulty in swallowing, and also having mild shortness of breath. After admission, investigations revealed high serum creatine phosphokinase levels of 2892 mg/dl, white blood cell count: 19,000, serum creatinine: 1.4 mg/dl, and serum lithium: 0.4 meq/l. Other investigations, such as an electrocardiogram, 2D echo, computed tomography brain plain, urine, blood culture, and sensitivity, were normal. A diagnosis of lithium-/SSRI-induced NMS was made, and appropriate treatment was given; the patient stayed in the hospital for 3 weeks and was discharged in a stable condition.
Arvid Carlsson’s discoveries transformed psychiatry by establishing a direct neurochemical basis for mental illness. By conclusively demonstrating dopamine as a neurotransmitter and elucidating its role in brain function, Carlsson laid the groundwork for biological models of schizophrenia and modern psychopharmacology. His work provided the scientific rationale for antipsychotic drug action and marked a paradigm shift from descriptive phenomenology to neurobiology-based psychiatry. Awarded the Nobel Prize in Physiology or Medicine in 2000, Carlsson’s contributions – alongside Paul Greengard and Eric R. Kandel – unified neurotransmission, intracellular signaling, and synaptic plasticity. This article reviews Carlsson’s life, experimental discoveries, the dopamine hypothesis of schizophrenia, and the enduring relevance of his work in shaping contemporary neuroscience-driven psychiatric practice.
Background: Medical education is academically demanding and emotionally challenging, influencing students’ attitudes, expectations, experiences, and overall quality of life (QOL). Understanding these dimensions is essential for promoting student well-being and optimizing medical training. Aim: The aim of this study was to assess attitude, expectations, experiences, and QOL among medical students in a tertiary care teaching hospital. Materials and Methods: This cross-sectional observational study included 500 undergraduate and postgraduate (PG) medical students. Data were collected using a structured sociodemographic pro forma, a self-administered questionnaire assessing attitude, expectations, and experiences related to medical education, and the World Health Organization QOL-BREF (WHOQOL-BREF) instrument for QOL assessment. Statistical analysis was performed using SPSS, with appropriate descriptive and inferential tests applied. Results: The mean age of participants was 21.8 ± 2.4 years, with an almost equal gender distribution. A positive attitude toward medical education was observed in 68.4% of students, while 60.2% reported that their expectations were met during training. Positive academic experiences were reported by 65.8% of participants. The mean WHOQOL-BREF total score was 81.4 ± 10.6, indicating an overall satisfactory QOL. Undergraduate students showed significantly higher physical and environmental domain scores, whereas PG students demonstrated better social relationship scores. Psychological health and total QOL scores were comparable between the two groups. Conclusion: Most medical students exhibited positive attitudes, reasonable fulfillment of expectations, and satisfactory QOL. Domain-specific differences in QOL between undergraduate and PG students highlight the need for targeted academic and psychosocial support measures to enhance student well-being throughout medical training.
Background: Emotional maturity and personality traits influence how individuals perceive and respond to stress and navigate interpersonal relationships, and they are central to depression and obsessive compulsive disorder (OCD). Aim: To assess and compare emotional maturity, personality profile, and quality of life (QoL) in treatment-naïve patients with depression and OCD. Methods This cross-sectional, comparative study was conducted at a tertiary care hospital between January 2022 and June 2023. A total of 100 participants were selected using consecutive sampling technique (50 with depression and 50 with OCD). Emotional maturity was assessed using the Bhargav and Singh Emotional Maturity Scale, personality traits via the Eysenck Personality Questionnaire Revised-Abbreviated, and QoL using the 36-Item Short Form Health Survey. Symptom severity was measured using the Hamilton Depression Rating Scale and the Yale-Brown Obsessive–Compulsive Scale. Results Patients with depression had significantly higher emotional regression (P = 0.003) and social maladjustment (P = 0.03) compared to patients with OCD. Psychoticism (P = 0.03) was significantly higher in patients with depression, whereas patients with OCD had significantly higher extraversion (P = 0.001) and lie scale score (P = 0.02). Patients with OCD had significantly poor QoL in functional state (P < 0.001) and emotional well-being (P < 0.001), whereas patients with depression had significantly higher scores in general heath (P < 0.001) QoL. Conclusion Patients with depression have emotional regressive behavior and social maladjustment when compared to OCD. Depressive patients are more reserved, quiet, introspective, empathetic, tender-minded, likely to have socially desirable behavior personality traits compared to OCD. Patients with depression and OCD had impairment in most of the domains such as physical functioning, emotional problems, and role limitation. Early identification and management may be associated with improved QoL in these patients.
Background: Benzodiazepines (BZDs) are among the most commonly prescribed psychotropic drugs, but they carry a high risk of developing tolerance, dependence, and withdrawal effects. In India, their prolonged and often unmonitored use has become an increasing public health concern. Aim: This study aimed to examine the clinical profiles and demographic features of patients with BZD dependence attending a tertiary care hospital in South India. Materials and Methods: A cross-sectional descriptive study was carried out between December 2022 and January 2025 at a tertiary care center in Karnataka, India. A total of 64 individuals with a history of BZD use were assessed according to ICD-10 diagnostic guidelines. Data were obtained using a semi-structured pro forma and analyzed with SPSS software (version 25). Results: The participants had a mean age of 44.4 ± 12.9 years, with males comprising 52.4% of the sample. The average duration of BZD use was 4.6 ± 3.7 years. Somatoform disorders (23.8%) were the most frequent reason for prescription, followed by generalised anxiety disorder (15.9%). Clonazepam was the most commonly used medication (76.2%). A family history of substance use was observed in 65.1% of cases. The most frequent withdrawal symptoms were sleep disturbances (58.7%) and panic attacks (20.6%). Conclusion: BZD dependence was found predominantly among middle-aged adults in the tertiary care population, with clonazepam being the leading prescribed drug. These findings point to the need for improved prescribing practices, enhanced clinician training, tighter regulatory oversight, and greater public education to mitigate the rising challenge of BZD dependence in India.
Background: The rapid integration of artificial intelligence (AI) into healthcare necessitates an understanding of medical interns’ preparedness to engage with AI-enabled systems. This study assessed the knowledge, attitudes, and readiness of medical interns toward AI in healthcare to inform the need for a structured elective course. Study Design and Methodology: A cross-sectional and observational study was conducted over 6 months, among 141 MBBS interns at a tertiary care teaching institute in Vadodara, India. The study was approved by the institutional ethics committee. Data were collected using a structured Google-based questionnaire assessing AI knowledge and attitudes, along with the validated Medical AI Readiness Scale for Medical Students (MAIRS-MS). Results: The mean age of the participants was 23.11 years, with 56% males. Only 27.7% had received formal education on AI and 72.3% had not engaged in AI-related discussions during internship. While 78.7% demonstrated adequate basic knowledge of AI concepts, attitudes were mixed: 44.7% viewed AI as transformative for healthcare and 36.2% reported ethical concerns. Only 34.8% expressed confidence in working with AI. MAIRS-MS scores indicated foundational knowledge with variable readiness across domains. Conclusion: Medical interns demonstrated basic knowledge of AI, gaps in confidence, and readiness for clinical application persist. These findings support the need for targeted educational interventions, including an elective course in AI, to better prepare future medical professionals for the integration of AI in healthcare.
Background: Despite its considerable health risks, the growing prevalence of smartphone dependence among adolescents is a serious issue that often goes unnoticed. This study aims to determine the prevalence and predictors of mobile phone dependence among school-going children. Methodology: A cross-sectional study was conducted among 222 school-going children aged 10–18 years in urban Mysuru, South India, from November 2023 to March 2024. A standardized self-administered questionnaire was employed for data collection. Mobile phone dependence was assessed using a self-designed 20-item Mobile Phone Dependence Scale. Data were analyzed using SPSS Version 23. Results: The prevalence of mobile phone dependence in the participants was 60.4%. High school children showed significantly higher rates of mobile phone addiction (P = 0.004). Children who owned smartphones (98.5%) and had access to the Internet (97.8%) showed a higher prevalence of dependence. The children with mobile phone dependence showed blurry vision (77.1%), tingling sensation (87.5%), and burning sensation in the eyes (86.3%). Having own mobile phone (odds ratio [OR] 6.109, 95% confidence interval [CI] 1.084–34.404) and the duration of mobile phone use (OR 1.379, 95% CI 1.13–1.683) were independent predictors of mobile phone addiction. Conclusion: Smartphone dependence is highly prevalent among school-going children, particularly adolescents. Access to personal mobile phones and longer duration of mobile phone use emerged as significant predictors of dependence. Early preventive strategies, awareness programs, and parental regulation of mobile phone use are essential to mitigate the growing public health concern of mobile phone dependence among children.
Neurocysticercosis (NCC) commonly manifests as neurological symptoms, including seizures. Psychiatric manifestations also occur frequently, the most common presentation being depression. Causes include underlying inflammation due to degeneration of viable cysts, psychological burden of being diagnosed with NCC, and vigorous treatment procedures, including recurrent admissions. In this article, we report the case of a young adult female who initially manifested with only depressive symptoms in the absence of any significant stressor, not responding to antidepressant treatment, later developing recurrent uncontrolled seizures, and eventually being diagnosed with NCC using neuroimaging and serological tests. Treatment of NCC with albendazole and steroids, along with levitiracetam to control seizures, followed by re-institution of antidepressant paroxetine, led to complete remission of her symptoms. Literature is available for cases of NCC where psychiatric symptoms occurred concurrently, or after the onset of seizures, whereas the case reported here initially presented solely with depression, which makes it unique, and difficult to diagnose. The case described here is a reminder for clinicians regarding the importance of detailed history taking and ruling out organicity before making a psychiatric diagnosis.
Hikikomori refers to a state of extreme social withdrawal that leads to marked impairment in daily functioning .Although originally described in Japan, increasing cases are being reported worldwide. We describe a 16-year-old boy from India who developed progressive social isolation following the COVID-19 lockdown, associated with excessive online gaming. Over two years, his gaming increased to six to seven hours daily, resulting in school dropout, poor self-care, sleep disturbance and irritability. He later developed suspiciousness and occasional muttering to self. Developmental history revealed longstanding inattention and hyperactivity. Medical evaluation was unremarkable. He scored 68/100 on the 25-item Hikikomori Questionnaire, indicating high risk. Treatment with risperidone and atomoxetine and structured psychosocial interventions led to significant improvement in psychotic symptoms; however, social withdrawal persisted at follow-up. The case highlights the emerging relevance of hikikomori in the Indian context and the importance of early, integrated intervention in such cases.
