Background: The risk of COVID-19 infection and related health consequences is higher among persons with mental illnesses (PMI). Vaccines have had an impact in reducing the morbidity and mortality in patients with COVID-19 infection. Understanding the reasons for vaccine hesitancy in PMI is crucial for promoting vaccine acceptance in this population, but it remains an under-researched topic. Aims: This cross-sectional study assessed perspectives among unvaccinated PMI regarding COVID-19 vaccination in a tertiary care teaching hospital. Factors associated with vaccine hesitancy in this population were explored. Materials and Methods: One-hundred consecutive PMI attending the psychiatric outpatient clinic who had not taken the COVID-19 vaccination were recruited after obtaining informed consent. A semi-structured questionnaire was used to elicit knowledge, attitudes, and practices regarding COVID-19 vaccination. The Oxford vaccine hesitancy scale was used to assess vaccine hesitancy; the Brief Psychiatric Rating Scale and Depression Anxiety Stress Scale-21 were administered to assess current psychopathology. Results: A majority of the participants (62%) were unwilling for the vaccination, the most common reasons being the perception that they were not at risk of infection, and worry about the possible side effects of the vaccination. Factors associated with low vaccine hesitancy were higher levels of education, greater perception of the risk of contracting the disease, belief that vaccination was effective, and easy accessibility to the vaccine. Conclusion: Improving awareness, providing accurate information, and ensuring better accessibility to vaccines are necessary to improve vaccine coverage among PMI. Mental health professionals need to assume an active role in providing education and clarifying misconceptions among our vulnerable patient population to help mitigate vaccine hesitancy.

Background: Antipsychotic medications remain the mainstay in the treatment of schizophrenia. Haematological side effects of antipsychotics are not commonly reported. Neutropenia or agranulocytosis is commonly associated with Clozapine, though an increased risk for leukopenia/neutropenia have been suggested with Olanzapine, Risperidone and Chlorpromazine. We report a patient with schizophrenia who developed reversible neutropenia on treatment with Olanzapine. Case Presentation: A 30-year-old man, presented to the outpatient clinic, three years ago, with one year history of psychotic symptoms. A diagnosis of schizophrenia was considered and his symptoms remitted with Olanzapine 25 mg per day. He did not have any medical comorbidities. Following discontinuation of medications, he presented with a relapse of symptoms. In view of good response in the past, he was restarted on Olanzapine as baseline investigations were normal. During titration of Olanzapine, at 15 mg/day, his total white blood cell counts reduced to 2700/mm3 with absolute neutrophil count of 1215/mm3. In consultation with a haematologist, medical causes for neutropenia were ruled out. A possibility of Olanzapine induced neutropenia was considered. Olanzapine was stopped and Haloperidol trial was initiated, following which cell counts normalized in a week. Discussion: Various mechanisms have been proposed for Olanzapine associated neutropenia including direct toxicity or even immune mediated. A previous report has documented cross sensitization between Clozapine and Olanzapine. This patient developed neutropenia despite tolerating Olanzapine previously. Hence sensitization during the previous trial is a possibility. This report adds to the existing knowledge about haematological side effects of Olanzapine and should inform clinical practice.

BACKGROUND:Indian society is considered to have conservative attitudes regarding sex and is ambivalent about the concept of sex education. Previous reports suggest that a considerable proportion of Indian youth have inadequate sexual knowledge and hold a variety of sexual misconceptions. Methodological flaws limit the generalizability of some earlier studies.AIMS:This study assessed knowledge and attitude toward sexual health and common sexual practices among college students in Tamil Nadu.METHODOLOGY:A total of 952 students from seven randomly selected colleges in Vellore district of Tamil Nadu participated in the survey. The survey questionnaire contained 51 questions on knowledge and attitude toward sexual health and common sexual practices and incorporated items from standardized questionnaires and additional questions suggested by a multidisciplinary group who work in the field.RESULTS:Two hundred seventy-five students among those who completed the survey were women. Higher knowledge scores were associated with older age, male gender, being from a rural background, pursuing non-science streams, and being in postgraduate courses. Nonconservative attitudes were associated with older age, male gender, enrollment in non-science disciplines, discomfort with the family environment, and a religious family background.CONCLUSIONS:Sexual knowledge is inadequate and sexual misconceptions were widely prevalent in the population studied. School-based comprehensive sex education programs, which have been demonstrated to be effective in improving sexual health, could be used to deal with these lacunae in sexual health knowledge and attitudes.

Background: Cognitive deficits, self-reported or found following electroconvulsive therapy (ECT), and their correlates are diverse. Despite the characteristics of people receiving ECT in Asia differ widely from the west, pertinent research from Asia remains sparse. Methods: We investigated the correlates of self-reported, mini-mental status examination (MMSE) defined, and autobiographical memory deficits in a cohort that received ECT in a south Indian tertiary-care setting. 76 consecutive consenting people were recruited within seven days of completing their ECT course. Memory was assessed by a subjective Likert scale, MMSE, and an autobiographical memory scale (AMS). Psychopathology was assessed by brief psychiatric rating scale, and serum cortisol levels were estimated by chemi-luminescence immunoassays. Relevant sociodemographic and clinical data were collected from the participants, and their medical records. The correlates were analysed using generalised linear models after adjusting for the effects of potential confounders. Results: Self-reported, MMSE-defined, and autobiographical memory deficits were present in 27.6% (95% CI 17.6-37.7%), 42.1% (95% CI 31.0-53.2%), and 36.8% (95% CI 26.0-47.7%) of participants, respectively. Agreement between the memory deficits was poor. Age, less education, duration of illness, hypothyroidism, and past history of another ECT course were significantly associated with MMSE-defined deficits. Age, anaemia, past ECT course, and pre-ECT blood pressure were significantly associated with autobiographical memory deficits, while residual psychopathology and cortisol levels were significantly associated with self-reported memory deficits. Conclusion: Self-reported, MMSE-defined, and autobiographical memory deficits are common at the completion of ECT course, and their correlates differ. All service users receiving ECT need periodic cognitive assessments evaluating multiple cognitive domains.

Background and Aim: There is a dearth of community data on nature, prevalence, clinical features, and explanatory models related to sexual dysfunction among men, particularly from rural India. This study attempted to examine different aspects of male sexual dysfunction and misconceptions in the community. Materials and Methods: Villages in Kaniyambadi Block, Vellore district were stratified, and four were randomly selected. Men living in these villages were recruited for the study. The following instruments were administered: (i) International Index of Erectile Function, (ii) Chinese Index of Premature Ejaculation (iii) Short Explanatory Model Interview, and (iv) Revised Clinical Interview Schedule. The data were analyzed using standard bivariate and multivariate statistics. Results: A total of 211 men were recruited. The majority were middle-aged (mean 40.73 years), literate (84.8%), married, and with children (72%), from nuclear families (99.6%), followed the Hindu religion (87.7%), reported satisfaction with their marriage (51.2%), had a single sexual partner (99.5%), and practised contraception (88.2%). A minority reported erectile dysfunction (29.9%), premature ejaculation (19.4%), and depression/anxiety (30.8%). Erectile dysfunction was associated with single marital status (P < 0.001), premature ejaculation (P < 0.001), worry about nocturnal emission and loss of semen (P < 0.02), and punishment by God as causal beliefs (P < 0.001). Premature ejaculation was associated with diabetes mellitus (P < 0.05), alcohol use (P < 0.05), anxiety and depression (P < 0.01), guilt about masturbation (P < 0.001), and belief that nocturnal emission is causal (P < 0.001) and erectile dysfunction (P < 0.05). Conclusion: Sexual misconception and dysfunction in men are significant problems in rural communities in India. They mandate the need for sex education in schools and the empowerment of physicians in primary and secondary care to manage such problems.

BACKGROUND:Sexual dysfunction, common in general medical practice, is under-recognized and inadequately managed resulting in significant morbidity and reduction in quality of life. We examined the nature, prevalence, clinical features and explanatory models of illness among men with sexual dysfunction in a general healthcare setting.METHODS:We recruited 270 consecutive men attending a general health clinic. Participants were evaluated using a structured interview. The International Index of Erectile Function-5, the Chinese Index of Premature Ejaculation-5, Short Explanatory Model Interview and the Revised Clinical Interview Schedule were used to assess sexual dysfunction, explanatory models and psychiatric morbidity.RESULTS:Premature ejaculation and erectile dysfunction were reported by 43.0% and 47.8% of men, respectively. The most common perceived causes were loss of semen due to masturbation and nocturnal emission. Popular treatments were herbal remedies and resources used were traditional healers. The factors associated with erectile dysfunction were diabetes mellitus, financial stress, past history of psychiatric treatment and common mental disorders such as depression and anxiety; those associated with premature ejaculation were common mental disorders, older age and financial debt. Sexual dysfunctions and concerns were under-diagnosed by physicians when compared to the research interview.CONCLUSION:There is a need to recognize sexual problems and effectively manage them in general medical settings. The need for sex education in schools and through the mass media, to remove sexual misconceptions, cannot be under-emphasized.

Anejaculation is an uncommon clinical entity that may result from a variety of causes, both organic and psychological. Psychogenic anejaculation is influenced by relationship, behavioral, and psychological factors. We present a clinical case of situational anejaculation, which was managed with a combination of techniques that addressed these factors including changes in masturbatory technique, improved marital communication and quality, and reduction of anxiety using cognitive behavioral techniques. It is suggested that the standard techniques of sex therapy be modified and tailored to manage the specific problems of the individual patient.

Byline: P. Thangadurai, K. Jacob Psychiatry, which has medicalized many forms of human distress, argues for individual treatments and interventions. It has blurred the disease-illness divide, subcategorized clinical presentations, lowered the thresholds for diagnosis and introduced many new psychiatric "disorders." Its phenomenological approach to diagnosis and classification employs symptom checklists and symptom counts sans context. The medicalization of distress is supported by the capitalistic project and the current political economy of health, fits in well with neoliberalism and allows the free market to expand its business interests. This essay contends that social and economic correlates of depression, anxiety and common mental disorders, despite robust evidence, are not emphasized. It argues that social and economic determinants of mental health demand public health and population-based strategies to prevent and manage common mental disorders in the community. Such approaches will impact a greater proportion of people than medical interventions. Depression and anxiety, standard psychiatric diagnoses, are part of our vocabulary and popular culture. However, these terms are employed to highlight "idioms of distress," describe illness experience and to label diagnostic categories. Their widespread, flexible and interchangeable use has blurred the boundary between distress and disease. The disease halo has been inappropriately transferred to many forms of human suffering. The medicalization of distress has resulted in a focus on treating individuals. It has also resulted in ignoring the impact of social and economic stress on mental health resulting in very little emphasis on the need for and use of public health and population-based interventions. Psychiatric Context Psychiatry in the 1970's was struggling with "unproven" etiologies for mental illness and with poor diagnostic agreement among psychiatrists. The discipline adopted an "atheoretical" approach to diagnosis using operational criteria, [sup][1] that emphasized reliability and counted symptoms. It dismissed the relevance of context and environmental stress to diagnosis, as these require interpretation and reduce inter-rater reliability. [sup][1],[2] The creation and use of the suffix "disorder" for psychiatric categories sidestepped the disease-illness divide. The discipline also created a diagnostic label called "major depressive disorder," which attempted to identify people with more severe distress and "clinical depression". [sup][1] It soon became the gold standard. The diagnosis of depression, when viewed through the biomedical lens, tends to suggest the disease, supposes brain etiology and pathogenesis, documents signs and symptoms, offers differential diagnoses, recommends pharmacological therapies and prognosticates about the course and outcome. However, psychiatric diagnoses pose many challenges. The lack of laboratory tests for diagnosis has forced psychiatrists to rely on clinical features. The absence of pathognomonic symptoms has meant the use of clinical syndromes for labeling and symptom checklists for diagnosis. The criteria essentially count symptoms with little regard for context. [sup][3] The recent increase in the number of psychiatric categories and the lowering of the clinical threshold has resulted in a wide net, which medicalizes a variety of normal human responses to environmental stress. Epidemiological studies of depression also use diagnostic instruments, which do not evaluate stress and context and fail to identify short-term adjustment problems. [sup][2] The elastic concept of depression and the rigid application of the diagnostic hierarchy and criteria has resulted in the marginalization of short-term stress-related adjustment disorders in clinical practice. Consequently, the hybrid category, major depressive disorder, identifies a heterogeneous group of people with melancholic depression (endogenous depression), those with chronic depression and with recent stressors (neurotic depression/dysthymia) and normal people under severe stress (adjustment disorders). …

Purpose: The relative contributions of psychiatric morbidity and psychosocial stress to suicide, and the efficacy of mental health systems in reducing population suicide rates, are currently unclear. This study, therefore, aimed to investigate whether national suicide rates are associated with their corresponding mental health system indicators.Methods: Relevant data were retrieved from the following sources: the World Health Organization, the United Nations Statistics Division and the Central Intelligence Agency World Fact book. Suicide rates of 191 countries were compared with their mental health system indicators using an ecological study design and multivariate non-parametric robust regression models.Results: Significant positive correlations between suicide rates and mental health system indicators (p < 0.001) were documented. After adjusting for the effects of major macroeconomic indices using multivariate analyses, numbers of psychiatrists (p = 0.006) and mental health beds (p < 0.001) were significantly positively associated with population suicide rates.Conclusions: Countries with better psychiatric services experience higher suicide rates. Although these associations should be interpreted with caution, as the issues are complex, we suggest that population-based public health strategies may have greater impact on national suicide rates than curative mental health services for individuals. (C) 2013 Elsevier Ltd. All rights reserved.

BACKGROUND:The relative contributions of psychosocial stress and psychiatric morbidity to suicide are a subject of debate. AIMS:To determine major risk factors for suicide in rural south India. METHOD:We used a matched case-control design and psychological autopsy to assess 100 consecutive suicides and 100 living controls matched for age, gender and neighbourhood. RESULTS:Thirty-seven (37%) of those who died by suicide had a DSM-III-R psychiatric diagnosis. Alcohol dependence (16%) and adjustment disorders (15%) were the most common categories. The prevalence rates for schizophrenia, major depressive episode and dysthymia were 2% each. Ongoing stress and chronic pain heightened the risk of suicide. Living alone and a break in a steady relationship within the past year were also significantly associated with suicide. CONCLUSIONS:Psychosocial stress and social isolation, rather than psychiatric morbidity, are risk factors for suicide in rural south India.

Back to table of contents Previous article Next article Letters to the EditorFull AccessReversible Neutropenia With Olanzapine Following Clozapine-Induced NeutropeniaP. Thangadurai D.P.M.K.S. Jyothi D.P.M.Rajesh Gopalakrishnan D.P.M., M.D.Anju Kuruvilla M.D.K.S. Jacob M.D., PH.D., M.R.C.PSYCH.,P. Thangadurai D.P.M.Search for more papers by this authorK.S. Jyothi D.P.M.Search for more papers by this authorRajesh Gopalakrishnan D.P.M., M.D.Search for more papers by this authorAnju Kuruvilla M.D.Search for more papers by this authorK.S. Jacob M.D., PH.D., M.R.C.PSYCH.Search for more papers by this author,Published Online:1 Jul 2006https://doi.org/10.1176/ajp.2006.163.7.1298AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: A major limitation with clozapine is the risk of agranulocytosis, which is observed in 1% of patients taking clozapine. In addition, olanzapine has been found to produce reversible neutropenia (1 , 2) . There are reports of both safe usage and the prolongation of granulocytopenia when olanzapine is used after clozapine-induced agranulocytosis (3 , 4) . We report a case in which a patient who had no adverse hematological responses to olanzapine developed neutropenia when he was re-exposed to olanzapine following clozapine-induced neutropenia. A 31-year-old Asian man with schizophrenia remained well for two years. He had been taking 20 mg of olanzapine, with no positive symptoms and minimal negative symptoms. Six months after the dose was gradually reduced, he developed a relapse of psychotic symptoms. He received sequential trials of risperidone (8 mg), olanzapine (30 mg), and a course of electroconvulsive therapy (because of severe agitation and suicidal and homicidal risks). During this period, his total white blood cell count ranged from 8,300/mm 3 to 10,200/mm 3 . As he remained symptomatic, a trial of clozapine was considered. A preclozapine laboratory test was unremarkable. While there was a significant reduction in psychotic symptoms, the patient’s total white blood cell count dropped to 2,100/mm 3 , and he developed a chest infection in the fifth week of treatment. Clozapine was discontinued, and oral cephalosporins and quinolones were started. The patient’s physical condition improved, and his white blood cell count normalized to 7,900/mm 3 within 10 days. He was restarted on a regimen of olanzapine and remained hematologically stable during the subsequent 2 weeks, with white blood cell counts of 7,600/mm 3 and 7,900/mm 3 . However, during the third week after normal white blood cell counts, his cell count decreased again to 3,600/mm 3 and later to 3,200/mm 3 . Olanzapine was discontinued, and within a week the total white blood cell count rose to 10,100/mm 3 . Clinical history, physical examination, and laboratory tests did not show evidence of any other medical disorder. To date, there are no reports of neutropenia in patients who have been previously hematologically stable on olanzapine when re-exposed to it following clozapine-induced neutropenia or agranulocytosis. In addition, there is no literature on the mechanism of olanzapine-induced neutropenia, but in view of its structural similarity to clozapine, similar mechanisms may be responsible. Previous reports have suggested that olanzapine can be safely administered to patients who develop agranulocytosis while taking clozapine (3) . Our report cautions against such use and raises the possibility that exposure to clozapine could sensitize the immune system, making it susceptible to olanzapine-induced neutropenia. Our experience suggests that patients who develop clozapine-induced neutropenia should have their neutrophil count monitored regularly during treatment with olanzapine, even if they have not had any hematological adverse effects with olanzapine in the past. Vellore, Tamilnadu, IndiaReferences1. Tolosa-Vilella C, Ruiz-Ripoll A, Mari-Alfonso B, Naval-Sendra E: Olanzapine-induced agranulocytosis: a case report and review of the literature. Prog Neuropsychopharmacol Biol Psychiatry 2002; 26:411–414Google Scholar2. Benedetti F, Cavallaro R, Smeraldi E: Olanzapine-induced neutropenia after clozapine-induced neutropenia. Lancet 1999; 354:567Google Scholar3. Konakanchi R, Grace JJ, Szarowicz R, Pato MT: Olanzapine prolongation of granulocytopenia after clozapine discontinuation. J Clin Psychopharmacol 2000; 20:703–704Google Scholar4. Dernovsek MZ, Tavcar R: Olanzapine appears haematologically safe in patients who developed blood dyscrasia on clozapine and risperidone. Int Clin Psychopharmacol 2000; 15:237–823Google Scholar FiguresReferencesCited byDetailsCited byGeneral Psychiatry, Vol. 31, No. 2Clozapine-Induced Late Agranulocytosis and Severe Neutropenia Complicated with Streptococcus pneumonia , Venous Thromboembolism, and Allergic Vasculitis in Treatment-Resistant Female PsychosisCase Reports in Medicine, Vol. 2015Turkish Journal of Emergency Medicine, Vol. 14, No. 1The Psychiatrist, Vol. 35, No. 1Irish Journal of Medical Science, Vol. 179, No. 2Human Psychopharmacology: Clinical and Experimental, Vol. 23, No. S1Reversible Delayed Onset Olanzapine-Associated Leukopenia and Neutropenia in a Clozapine-Naive Patient on Concomitant Depot AntipsychoticJournal of Clinical Psychopharmacology, Vol. 27, No. 4Pharmacoepidemiology and Drug Safety, Vol. 16, No. 1Pharmacoepidemiology and Drug Safety, Vol. 16, No. 12 Volume 163Issue 7 July, 2006Pages 1298-1298THE AMERICAN JOURNAL OF PSYCHIATRY July 2006 Volume 163 Number 7 Metrics PDF download History Published online 1 July 2006 Published in print 1 July 2006

We read with interest the article by Pillmann & Marneros ([2005][1]). Acute and transient psychosis is a common clinical presentation in the developing world. We retrieved medical records of all patients with psychotic disorders (F06.0–06.3, F20–29, F30.2, F31.2, F31.5, F32.3, F33.3) who