Background: Sexual dysfunctions (SDs) are common and lead to psychological distress and impair quality of life (QOL). However, little attention has been paid to explore SD in severe mental illnesses (SMIs). Hence, this study aimed to evaluate the occurrence of SD and its impact on the QOL in persons suffering from schizophrenia, bipolar disorder, and depression and compare it with healthy controls. Materials and Methods: In this cross-sectional study, 79 clinically stable patients and 50 healthy controls underwent evaluation for SD on the Arizona Sexual Experience Scale, and their QOL was measured using the WHO QOL-BREF scale. Chi-square test was used for the categorical variables, whereas comparison of continuous variables was done by t-test with post hoc corrections. Results: Compared to healthy controls, patients with depression had significantly higher rates of SD in the domain of obtaining penile erection (P = 0.019), ability to reach orgasm (P = 0.03), and satisfaction from orgasm (P = 0.01). Patients with schizophrenia had higher rates of problems in achieving arousal (P < 0.01), penile erection (P = 0.03), and satisfaction from orgasm (P = 0.03), whereas those with bipolar disorder only differed significantly on the domain of ability to reach orgasm (P = 0.03). However, patients fared better than the controls on various domains of QOL (except social domain). Conclusion: A significant number of patients with SMI suffer from SD. Hence, it should be made a routine practice to evaluate and address the problem of SDs in patients with SMI.

Background: Managing patients with suicide attempts effectively requires overcoming barriers to their care. The attitudes and beliefs of the healthcare professionals have significant effect on the outcome of the treatment and implementation of the preventive strategies. Objectives: Aim of the study was to assess the attitude of nursing students toward suicide prevention. Materials and Methods: The study had a cross sectional design of 284 nursing students who were randomly recruited from the two institutions. Attitude toward suicide prevention scale was administered. Results: Most were young single females, from rural locality, who were pursuing either BSc Nursing or GNM courses. Very few had previous exposure to suicide prevention training programmes. Nearly half of the students showed favourable attitude towards patients with suicidal attempt, considering it as their responsibility and their efforts as rewarding. Nearly half students also showed empathy towards these patients not considering the attempts as just attention seeking ones. Nearly one third were uncertain whether the patients reveal their plans of attempt and whether the suicide prevention measures were draining of the resources. Half of the subjects showed pessimism towards modifying the risk factors of unemployment and poverty. Conclusions: Only half of the nursing students showed favourable attitude working with patients with suicide attempts. More educational and training programs on suicide prevention are therefore needed in these students for better prevention and management of these patients.

Background: Suicide being a global health issue, the attitudes and beliefs of the healthcare professionals towards these attempters have significant effect on the outcome of the treatment. Objectives: Aim of the study was to assess the attitude of nursing students towards patients with suicide attempt. Materials and Methods: The study had a cross sectional design of 284 nursing students who were randomly recruited from the two institutions. Suicide opinion Questionnaire was administered. Results: Most were young single females, from rural locality, who were pursuing either BSc Nursing or GNM courses. Very few had previous exposure to suicide prevention training programmes. More than half of the students showed favourable attitude towards patients with suicidal attempt. Majority of students showed favourable attitudes for more than half of the attitudinal statements giving importance to the mental illness, disturbed family life, and depression and risk factors for suicide attempt. Unfavourable and uncertain attitude was noticed for a few of the statements. Conclusions: The nursing students showed favourable attitude towards patients with suicide attempts. More educational and training programs are therefore needed in these students for improving the uncertain and unfavourable responses to a few of these attitudes for better management of these patients.

A total of 203 consecutive patients were assessed on a delirium experience questionnaire 24 hours after recovery from delirium. One third (35%) of the patients could recollect their experiences during the delirium, and the majority (86%) of them were distressed by these experiences. The level of distress was moderate in most of the subjects (52.5%). Fear and visual hallucination were the most common distressing themes recollected. When the patients who could recall their experience of delirium were compared with those who could not recall, the authors noted that recall of delirium experience was associated with a higher prevalence of perceptual disturbances and language disturbances and a higher severity of delirium.

This study aimed to evaluate the symptom threshold for making the diagnosis of catatonia. Further the objectives were to (1) to study the factor solution of Bush Francis Catatonia Rating Scale (BFCRS); (2) To compare the prevalence and symptom profile of catatonia in patients with psychotic and mood disorders among patients admitted to the psychiatry inpatient of a general hospital psychiatric unit. 201 patients were screened for presence of catatonia by using BFCRS. By using cluster analysis, discriminant analysis, ROC curve, sensitivity and specificity analysis, data suggested that a threshold of 3 symptoms was able to correctly categorize 89.4% of patients with catatonia and 100% of patients without catatonia. Prevalence of catatonia was 9.45%. There was no difference in the prevalence rate and symptom profile of catatonia between those with schizophrenia and mood disorders (i.e., unipolar depression and bipolar affective disorder). Factor analysis of the data yielded 2 factor solutions, i.e., retarded and excited catatonia. To conclude this study suggests that presence of 3 symptoms for making the diagnosis of catatonia can correctly distinguish patients with and without catatonia. This is compatible with the recommendations of DSM-5. Prevalence of catatonia is almost equal in patients with schizophrenia and mood disorders.

Background: Although many studies in schizophrenia have evaluated health-care needs, there is a lack of data on the needs of patients with bipolar affective disorder (BPAD), with only occasional studies evaluating them, and no study has evaluated the relationship of health-care needs of patients with caregiver's burden. Aim: To study the relationship of caregiver's burden and needs of patients as perceived by caregivers of patients with BPAD and schizophrenia. Method: Caregivers of patients with BPAD and schizophrenia were assessed using the Camberwell Assessment of Needs - Research version (CAN-R) and Supplementary Needs Assessment Scale (SNAS), the Family Burden Interview schedule (FBI) and the Involvement Evaluation Questionnaire (IEQ). Results: Mean total needs of patients on CAN-R were 7.54 (SD 3.59) and 7.58 (SD 4.24) for BPAD and schizophrenia respectively. Mean total needs for SNAS were 7.24 (SD 3.67) and 7.68 (SD 5.02) for BPAD and schizophrenia groups, respectively. Total objective and subjective burden as assessed on FBI was significantly more for the schizophrenia group. Caregivers of patients with BPAD perceived significantly less disruption of routine family activities and lower impact on the mental health of others. On IEQ, the mean score on the domain of supervision was significantly higher for the BPAD group. In the schizophrenia group, positive correlations were seen between the total number of unmet and total (met and unmet) needs and certain aspects of burden, but no such correlations emerged in the BPAD group. Conclusion: There is no correlation between number of needs and burden in the BPAD group; however, in the schizophrenia group the number of needs correlated with the perceived burden. Accordingly, orienting services to address needs of patients with schizophrenia can lead to reduction in burden among caregivers.

In the present context, steroids are important therapeutic agents used in the management of various diseases. Existing literature suggests that various steroids are associated with psychiatric manifestations such as psychosis, depression, mania, dementia/cognitive impairment, delirium, etc. However, reports of such associations among elderly are limited. In this report, we present the case of an 80-year-old male who developed mania while taking dexamethasone and required management with olanzapine.

Aim The aim of this study was to determine the prevalence of catatonic symptoms, as per the B ush F rancis C atatonia R ating S cale ( BFCRS ), in patients with delirium and to evaluate the prevalence of catatonia as defined by the B ush F rancis C atatonia S creening I nstrument and DSM ‐5 criteria in patients with delirium. Method Two hundred five consecutive subjects with delirium were assessed on the Delirium Rating Scale‐Revised 98 version, the amended D elirium M otor S ymptom S cale and the BFCRS . Results On the BFCRS , two‐fifths ( n = 80; 39%) of the study participants had two or more catatonic symptoms. When the diagnosis of catatonic syndrome was considered, 32% and 12.7% were observed to have catatonia as per the B ush F rancis C atatonia S creening Instrument and proposed DSM ‐5 criteria, respectively. Delirium with catatonic syndrome was more common in women and in those who had onset of delirium prior to hospitalization. Amongst the delirium subtypes, hypoactive delirium was more commonly associated with catatonic syndrome. Conclusion The present study suggests that a substantial number of patients with delirium have catatonic symptoms and a significant proportion have catatonic syndrome. This high prevalence makes the concurrent diagnosis of delirium and catatonia plausible. The association of catatonia with a specific motor subtype of delirium could encourage the expansion or even modification of the existing subtypes of delirium.

BACKGROUND:Only a few studies have evaluated the similarities and differences between clinicians' and caregivers' rating of burden of caring for a person with chronic mental illness.AIM:To compare clinician-rated and caregiver-rated burden in a population of patients with either schizophrenia or bipolar disorder, using two different scales to measure caregiver burden.METHODOLOGY:Caregivers of patients with schizophrenia (n = 65) or bipolar disorder (n = 57) completed the Hindi version of the Involvement Evaluation Questionnaire (Hindi-IEQ) by themselves. Clinicians rated the burden on the Family Burden Interview Schedule (FBI) based on semi-structured interview with the same caregivers.RESULTS:Both total objective and subjective burden on the FBI (clinician ratings) demonstrated significant positive correlations with the total Hindi-IEQ (caregiver ratings) scores. Most areas of burden on the FBI correlated positively with the tension and the worrying-urging II subscales, as well as the total Hindi-IEQ scores. According to clinicians, a significantly higher percentage of caregivers of patients with schizophrenia were experiencing a moderate to severe degree of subjective burden; objective burden in this group was also significantly higher in the domains of effect on the mental health of caregivers. Contrastingly, caregivers of patients with bipolar disorder judged burden to be higher in this group than schizophrenia.CONCLUSIONS:There were many areas of agreement as well as some significant discrepancies between clinicians' and caregivers' assessment of burden in this population of patients. This suggests that a comprehensive evaluation of burden should include assessments by both clinicians and caregivers of patients.

Background: Category vs. dimension is a classic debate in psychiatry. Applying age of onset of dependence (AOOD) to categorize opioid dependence into early- (EO) and late-onset (LO) types provides a unique opportunity to critically examine this debate. Aim: To study if EO and LO subjects differ significantly on ‘validating variables’ from five explanatory domains: Clinical (severity), genetic (family history), psychological (sensation-seeking and impulsivity), neuropsychological (attention–concentration and executive functions), and neurophysiological (P300-evoked response potential). Materials and Methods: In a cross-sectional design, 60 ICD-10 DCR-diagnosed opioid-dependent male subjects (30 with AOOD≤20 years and 30 with AOOD≥22 years) comprised the two index groups (EO and LO, respectively), with their respective age-matched control groups (EOC and LOC). They were administered an extensive battery of instruments and tests based on the above domains. Results: The two groups differed significantly on only three out of nearly 30 variables tested. However, there emerged a clear and consistent pattern of continuum of scores across the groups and across all the variables: The EO subjects were the most impaired or affected, the LO subjects were intermediate, and the control groups fared the best. Further, nine test variables correlated significantly and meaningfully with AOOD when the dichotomy was abolished and the sample was combined into one. Conclusions: These results suggest that, in this particular case, the variable AOOD is more meaningful when it is used as a dimension rather than for generating categories perforce.

BACKGROUND:There is limited on the risk factors and mortality in patients with delirium from India.AIM:This study aimed to evaluate the risk factors associated with delirium and inpatient mortality rates of patients diagnosed with delirium by psychiatry consultation liaison services.MATERIALS AND METHODS:Three hundred and thirty-one patients diagnosed as delirium by the psychiatry consultation liaison services were examined on standardized instruments: Delirium Rating Scale Revised 98 version (DRS-R-98), amended Delirium Motor Symptom Scale (DMSS), Delirium Etiology Checklist (DEC), Charlson Comorbidity index, and a checklist for assessment of risk factors.RESULTS:More than three medications as a risk factor and metabolic/endocrine disturbances as cause were observed to play largest role in development of delirium. The inpatient mortality rate was 12.4%. Compared to the survivor group, those who died were more likely to be young (<65 years), had significantly high rate of alcohol dependence and were more frequently restrained prior to development of delirium; of these only age <65 years and use of restraints emerged as the significant predictors of mortality in regression analysis.CONCLUSION:Age and use of restraints appears to be an important predictor mortality in patients with delirium.