Introduction: Cancer is a serious and potentially life-threatening illness which has an effect on physical and emotional wellbeing of patients and their families. The diagnosis of cancer in itself is a stressful event causing significant psychological distress. The aim of the present study was to find out the psychiatric co-morbidity among cancer patients and correlate the morbidity with type of cancer, its severity, treatment and other relevant variables. Methodology: It was a cross-sectional observational study. 226 consecutive patients were recruited for this study which was already diagnosed with malignancy. A detailed history from the patient and/or a reliable person who knew the patient well was taken as per pre-designed structured format. Diagnosis of psychiatric disorders was made according to ICD-10. [1] Results: The prevalence of Psychiatric co-morbidity in our study came out to be 35% with 95% Confidence Interval 29-42%. In our study we had observed that patients who were living alone had high percentage of psychiatric disorders as compared to those living with partners and this difference was found to be statistically significant. Conclusion: Significant percentage of patients with malignancy had co-morbid psychiatric illnesses. Patients with malignancy need careful assessment for the presence of psychiatric co-morbidity especially patients living without partners. Mental health professionals may be included in the treating team.

Background: The present study was done in a tertiary care centre of North India to know the profile of epilepsy. Methods: Total of 210 patients were selected during the period August, 2017 to July 2018 who attended outpatient clinic of the Department of Neurology, Indira Gandhi Medical College, Shimla, Himachal Pradesh. Detailed clinical history was taken, general physical examination, and routine blood examination were carried out. Results: Of all the cases, sex ratio (male:female) was 2.39:1. A high proportion of cases (43.3%) were from lowermiddle socio-economic group. 76.7% patients had generalized seizures. For 38.6% patients, frequency of seizures was more than 8 in the past 6 months. 71.9% of the patients were using only one anti-epileptic drug. Conclusions: Patients with seizures comprise a significant burden in inpatient department of developing countries.

Background: Psychiatric comorbidity with diabetes mellitus is common. Comorbidity of diabetes and psychiatric disorders can present in different patterns, which are associated with impaired quality of life, increased cost of care, poor treatment adherence, poor glycaemia control and increased emergency room visits. The present study was planned to assess the psychiatric comorbidity in type 2 diabetic patients at tertiary care hospital in a hilly state of North India. Objectives: To study the prevalence of psychiatric comorbidity among patients of type 2 diabetes mellitus and to study the association between psychiatric comorbidity, sociodemographic and clinical variables in such patients. Materials and Methods: A cross-sectional study was conducted after enrolling the eligible diabetic patients attending outpatient department services of medicine department, Indira Gandhi Medical College, Shimla. The Brief Illness Perception Questionnaire was used to assess the cognitive and emotional aspects of illness, Hamilton Depression Rating Scale for assessment of depression, Hamilton Anxiety Rating Scale for assessing severity of anxiety and Mini-International Neuropsychiatric Interview 6.0 for screening all major Axis I disorders. Results: Out of 320 patients of type 2 diabetes mellitus screened, 202 eligible patients were enrolled. Depression was the most common psychiatric comorbid illness present in (41.9%) patients. Depression was slightly higher in female patients and persons aged >50 years. Greater prevalence of depressive episodes was there in people with longer duration of diabetes. Conclusion: There were a significant percentage of diabetic patients having psychiatric illnesses. Their attitude towards these comorbidities may be changed by psychiatric counselling at regular intervals.

Background: Cognitive impairment is a common clinical condition among elderly patients suffering with depression and has a well-known aetiology. The present study planned to determine the prevalence of cognitive impairment and depression in geriatric patients attending Psychiatric outpatient department services. Methods: The study was a prospective cross-sectional one and carried out with a sound methodology on elderly patients attending the Psychiatric OPD of Indira Gandhi Medical College, Shimla-1, Himachal Pradesh. A total of 130 patients were screened, out of which 105 patients have fulfilled the inclusion criteria and enrolled after written informed consent form. The cognitive function and depression were assessed by using standardized Mini-Mental State Examination of Folstein (MMSE) and the Geriatric Depression Scale (GDS), respectively. Results: Prevalence of cognitive impairment was found 42.9% (44.2% in women, 35.5% in men), whereas the prevalence of depression was found 48.6% (56.30%women, 41.10% men) which was statistically significant (p<0.05). Conclusions: Cognitive impairment and depression were found to be more prevalent in the females than in the males. So, it is advised that psychiatrist should provide special attention for early detection and treatment of depressive symptoms in elderly patients suffering with cognitive impairment.

Background: To evaluate students’ perception and attitude towards psychiatry in comparison with other specialities like medicine, surgery, paediatrics, obstetrics & gynaecology, orthopaedics, radio diagnosis and dermatology seems to be a global issue and is an essential part of programs to improve the status of the profession. Methods: Perception of 98 1st year and 90 final year medical students from the Indira Gandhi Medical College, Shimla was recorded using a semi-structured questionnaire. Students provided their opinion about future career choices and perspective of these specialties in terms of work-life balance, challenging aspect, ability to help patients effectively, financial reward, reputation, and emotional stability; their preferences in life and interaction with psychiatrist and its impact. Results: Psychiatry was ranked less attractive among majority of the specialities under study, but was found more attractive than dermatology. Surgery was a high priority for 40 (41%) students while psychiatry was a high priority in only 8 (8.2%) first year students, while in final year, medicine was a high priority for 29 (32.2%) while psychiatry was a high priority in only 12 (18.8%) students. Psychiatry had higher emotional stability but the reputation was lower among all the specialities in both groups. Those who like psychiatry attributed more importance to an interesting and challenging job than to prestige and financial reward. Conclusion: Our study points out the fact that prejudices toward patients with mental dysfunctions and lack of confidence in the efficacy of psychiatric treatment should be specially targeted by the curriculum in the later part of undergraduate education.

Background: Suicide is the result of an act deliberately initiated and performed by a person in the full knowledge or expectation of its fatal outcome. Suicide attempts are a significant public health problem. The present study aimed to explore the variousclinical characteristics of suicideattempters in a tertiary care hospital of Shimla, Himachal Pradesh, a northern state of India.Methods: We conducted a descriptive study among patients with attempted suicide to the department of Psychiatry, Indira Gandhi Medical College (IGMC) Shimla. A structured, self-designed interview schedule and short-form revised Eyseneck personality questionnaire-Hindi (EPQRS-H) was used for data collection. Data was analyzed using Epi info software v 7.2.0.Results: There were total 77 participants in the study out of which 44 (57.1%) were females. Mean age (Standard deviation) of participants was 30.8 years (9.9 years). Relationship problems were the most common (48.1%) recent life event followed by health events (28.6%). Depression was found to be the most common diagnosis (62.3%). Pesticide consumption was the method of attempting suicide in 72.7% of females compared to 66.7% of males.Conclusions: Recent major life events especially relationship problems may lead to majority of suicide attempts. There is urgent need to focus on patients suffering from depression by health personnel as well as family members. The sale of the pesticides should be regulated to keep in check the misuse of the same.

The posterior half of the prostate has a smooth well-defined edge unlike anteriorly. Often, tumor extends close to the posterior margin, where it is controversial whether pathologists should measure the distance between the tumor and the margin. There are no published data regarding the significance of a close margin factoring in the anatomical location within the radical prostatectomy (RP). We identified 158 RPs with 39 anterior-predominant carcinomas and 119 cases with posterior-predominant cancer. Distances between the tumor and inked margin were measured with an ocular micrometer. Eighty-seven cases had no progression with a minimum 6-year follow-up (median, 8; range, 6-9). Eighteen cases had progression with a median time to progression of 2 years with all men progressing within 6 years after RP. There was no statistically significant difference in the risk of progression relative to distance of tumor to the posterior margin (P = .09). The mean distance of tumor to the anterior margin for the cases that progressed was 0.6 mm (median, 0.5 mm; range, 0.05-1.18) compared to 1.9 mm (median, 1.1; range, 0.02-4) for the cases that did not progress (P = .02). Of 7 cases with anterior-predominant tumors that progressed, 5 had tumor located less than 1 mm from the anterior margin. In conclusion, if cancer is present less than 1 mm from the anterior margin, there is an increased tendency to recur, and this finding should be included in pathology reports. However, close margins posteriorly are not clinically significant and should not be reported.

Background: This descriptive, cross sectional study identified the occurrence of burnout and some associated factors among nurses working in various departments at Indira Gandhi Medical College, Shimla, Himachal Pradesh, India which is a tertiary care health centre in the state.Methods: A total of 257 nurses screened in the hospital out of which 81 completed the study. Eighty-one nurses answered a self-administered questionnaire (sociodemographic aspects, working conditions, and Maslach Burnout Inventory). Mean scores were compared using ANOVA test. Student T-test was applied to compare mean scores between the groups.Results: All the participants were females (100%), with up to five years’ experience. High levels of emotional stress (45.7%) and depersonalization (24.7%) were identified, as well as low professional fulfilment (6.2%), and 8.6% presented burnout. The following factors were associated: high levels of emotional stress and always perform tasks very quickly (p=0.04) and receiving a salary incompatible to the effort employed (p=0.03); high levels of depersonalization and with up to five years’ experience (p=0.02) and often perform tasks very quickly (p=0.008). For 19.0%, at least two of the three dimensions pointed to high propensity to the syndrome.Conclusions: Searching for personal solutions for work problems must draw our attention, since it discourages health and work performance. Professionals may feel more fulfilled and satisfied by adjusting their work expectations. However, on a long-term basis, persisting in stressful work conditions enhances emotional exhaustion, depersonalization and feelings of low fulfilment at work.

Background: Medical education carries with it a great burden of stress that can result in depression. This study was conducted to assess the prevalence of depression in medical students and various factors contributing to depression in the institute.Methods: A stratified random sample of 280 students was evaluated using Beck Depression Inventory by investigators. Associations between depression and year of study, addiction like alcohol use, family problems, family history of depression and staying away from home were analysed by univariate analysis.Results: The overall prevalence of depression was found to be 30.0%. Among those with depression, a majority (93%) had mild and moderate degree of depression. The study depicted that 41.6% (35) of the depressed were females and 58.3% (49) were males. As per the cut-off scores, 196 students (69.9%) scored as normal (0-9), 60 (21.4%) as mild (10-18), 18 (6.4%) as moderate (19-29), 4 (1.4%) as severe (30-40) and 2 (0.7%) as very severe (>40) depression. The prevalence of depression was comparatively less among 1st and 2nd year medical students (17.1%) and the difference between the grade of depression and year of study was found to be not significant (χ2=148, P=0.13). The prevalence was found more among those with family problems and family history of depression.Conclusions: In our study, depression was quite prevalent among medical students of the region. Our findings stressed the importance of broad screening and psychiatric counselling of this vulnerable population more meticulously.

Background: Palpitation is a common presenting complaint in out patient department. Etiological profile of such patients has not been studied in the recent past. The aim of the study was to study the aetiological profile of patients with new onset palpitations in North Indian tertiary health care centre. Methods: 130 consecutive patients of new onset palpitations were enrolled in the study and the aetiological profile of palpitation was evaluated using detailed history, examination and investigations. Results: The study group had 53% female and 47% male with a ratio of 1.13:1. Majority of the patients in the age group of 18-29 years. The mean age was 32.04+15.14 years. Most common symptom associated was shortness of breath seen in 17% patients. Of the 130 patients 43.8% of patients had cardiac aetiology, 35.38% psychiatric and 20% had miscellaneous aetiology. Among cardiac aetiology, arrhythmias were most common. PSVT was encountered in 15.4% and AF in 13.1%of the total patients. Psychiatry causes were observed in 35% of patients. In psychiatric causes 71.7% patients had panic attack whereas 28.2% patients had generalised anxiety disorder (GAD). In third group of miscellaneous causes which was 20% of total 6.9% had anaemia, 10% hyperthyroidism and 3.8% were on beta agonists. Conclusions: Palpitation is a presenting symptom of various diseases. The cause can be easily ascertained in most of the patients by a good history and examination; serious cardiac diseases require special investigation. Palpitation as a symptom should not be overlooked the underlying cause must be identified; this can be a helpful clue to improve patient outcome.

Background: People suffering from mental illness commonly face stigma, bias, and discrimination by general public. Health care professionals are not immune to social biases and share the public's attitude meted out to people with mental illness. Nursing students are future health manpower. There are only few studies conducted on medical students’ attitude towards people with mental illnesses in India. We have planned this study to examine the undergraduate nursing students’ attitude towards people suffering from mental illnesses.Methods: It was a cross-sectional study. A total of 220 undergraduate nursing students were selected randomly with their consent to complete the Attitude Scale for Mental Illness (ASMI).Results: The nursing students were found to have a significant positive attitude towards mental illness in five of the six attitudes factors: Restrictiveness (8.42), benevolence (28.6) and stigmatization (7.3), separatism (15.6) and stereotype (9.4) However, these students had negative attitude in pessimistic predictions (12.5) domain as they rated this domain slightly on the higher side.Conclusions: Academic education in this field must be conceptualized and planned in order to favor the change of the attitudes that includes greater utilization of those teaching strategies that challenge beliefs and assumptions and promote a commitment to provide holistic care to people with mental illness.

Background: The alcohol use disorders are frequently associated with other co-morbid psychiatric disorders. The aim of this study was to describe the demographic variables, drinking history and psychiatric co-morbidity in alcohol dependent subjects.Methods: In this study, 40 consecutive patients were enrolled. After a minimum 1 month of sobriety, patients who fulfilled ICD-10 criteria of alcohol dependence were interviewed for data collection using Alcohol Use Disorders Identification Test (AUDIT), MINI-International Neuropsychiatric Interview (MINI) (Version-6.0) and a specially designed sociodemographic and clinical interview proforma. Subjects with substance use except tobacco were excluded from study. Main group comparison used chi-square test for categorical variables and the t-test for continuous variables.Results: Most of the patients studied were >40 years of age. Majority were employed (92%), lived in nuclear families (78%) and came from rural background (77.5%). Forty five percent of the patients initiated alcohol drinking between 16-25 years and reported peer pressure (50%) as most significant factor responsible for initiation of drinking alcohol. Mean age of developing alcohol dependence was 25.12 years (SD=4.28). Mean AUDIT score for subjects was 27.7 (SD=4.73). Lifetime psychiatric co-morbid disorders were detected in 45%. Psychiatric disorders most frequently associated with alcohol dependence were major depressive disorder (10%), bipolar affective disorder (7.5%), dysthymia (5%), anxiety disorders (7.5%) and antisocial personality disorder (5%).Conclusion: The study indicates that psychiatric disorders are prevalent in alcohol dependents and mood disorders are the most prevalent ones. It was also observed that co-morbid psychiatric disorders are associated with more severe alcohol problems.

Two patients with opium dependence developed delirium during abstinence. The delirium resolved completely within 48-58 hours of appropriate treatment. Caution needs to be exercised during opioid detoxification in timely detecting and treating potentially life-threatening condition like delirium.

Background: Depression in elderly is a public health problem. Aims and Objectives: To determine the prevalence of depression and its correlates among the elderly population. Materials and Methods: This cross-sectional study was conducted among elderly aged 60 years and above using two-stage cluster sampling technique among elderly residing in the rural and urban areas of Shimla district of Himachal Pradesh, India. A written consent was taken from each participant after explaining the purpose of the study. Results: Of the 800 subjects, 76 (9.5%) were found to be suffering from depression. The logistic regression analysis revealed that elderly having lower income, consuming tobacco, experiencing stressful life event in the past 1 year, having 3 or more chronic diseases, and lacking positive approach toward life and were found to be more depressed. Conclusion: The study conducted in Shimla district shows that one-tenth of the elderly residing in the study area suffering from depression. Elderly having lower income, residing in the urban area, experiencing significant life event, suffering from multimorbidity, and lacking positive approach toward life increase should be identified by screening. They should be focused on so as to reduce the probability of occurrence of depression.