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Introduction: Treatment adherence rates among patients of affective disorders remain sub-par across the world. Sociocultural factors affecting the same remain poorly understood. The current study aimed to explore and conceptualize the same. Methodology: The study utilized a qualitative grounded and phenomenological approach study design. The patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders - Fifth edition (DSM-5) criteria of unipolar depression or bipolar affective disorder, and were presently under our treatment for at least three months and currently in remission, aged 18-60 years, and were able to understand Hindi or English, scored less than 6 on the Medication Adherence Rating Scale were included. Furthermore, key caregivers were also included in the study. Using purposive sampling and data saturation, a total of 30 participants were recruited. In-depth interviews were conducted using the cultural formulation interview as given in DSM-5, which was used as the interview tool. Thematic analysis of data was performed using Atlas.ti version 8.4.3. Results: A total of 14 themes (deductive and inductive) emerging from 171 codes were identified. Some of the important inductive themes included cultural and societal attitude toward illness and treatment-seeking, trust, experience, and expectations from available health care, faith healing-related practices and beliefs. The implicit themes such as cultural understanding of the problem and cultural factors affecting help-seeking, also showed prudent findings. Conclusion: The study findings demonstrate the various features of the sociocultural milieu and identity of an individual and family that have an influence on treatment-seeking behavior.

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Objective: To assess user perception regarding different aspects of the telepsychiatry process.Methods: This cross-sectional survey study was conducted between July and September 2020 with follow-up patients attending teleconsultation at a tertiary care center (N = 108). The online survey included questions about the user's experience such as the appointment process and different aspects of teleconsultation, as well as perceived benefits, difficulties experienced, and suggestions for improvement. The sociodemographic and clinical data were retrieved from the electronic record.Results: The majority of patients expressed satisfaction with teleconsultation. The patients who were living far from the center (> 100 km) and those with psychotic illness favored telepsychiatry. Patients with nonpsychotic illnesses reported significantly less satisfaction with counseling in teleconsultation.Conclusions: The findings substantiate the acceptance of telepsychiatry services and emphasize the need for a tailor-made hybrid form of consultation as per the patient's profile.

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Objective: To explore the psychological impact of the coronavirus disease 2019 (COVID-19) pandemic and associated lockdown on patients with psychiatric illness.Methods: An online survey-based cross-sectional study was conducted among patients receiving follow-up treatment at a tertiary care center from January to March 2020. The data were collected using a questionnaire about the possible challenges in 3 broad areas: treatment-related challenges, psychosocial difficulties, and concerns related to COVID-19.Results: The majority of patients (72.6%) reported a positive impact due to the increased availability of family support. Patients with depression and anxiety disorders (39.0%) experienced a more negative impact compared to those with psychotic disorders. Many of the psychiatric patients (22.6%) stopped medications and had difficulties accessing health services. Patients also experienced increased interpersonal conflict, sleep difficulties, and a surge in screen time.Conclusions: The findings highlight the difficulties faced by patients with psychiatric illnesses and emphasize the importance of family cohesion during times of crisis.

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BACKGROUND: Delirium is a common occurrence in medically compromised adults, but, research is limited in the pediatric population especially from low- and middle-income countries such as India. AIMS: This study aimed to evaluate the emergence of delirium in children aged 5-18 years admitted to a pediatric intensive care unit (PICU) of a tertiary care hospital in North India. Other objectives included delineating the clinical characteristics of delirium and its clinical correlates. METHODOLOGY: It was a prospective cohort study in which all admitted children during a calendar year were assessed and those fulfilling the inclusion criteria were enrolled for study. The Pediatric Confusion Assessment Method Intensive Care Unit (p-CAM-ICU) scale was used to diagnose delirium. RESULTS: ut of 305 total admissions to the PICU, 105 children were included. More than two third were male (68.6%) with a median age of 11 years. The incidence of delirium was 11.4% and median duration of delirium was 2 days. Majority of the children had hypoactive delirium (58.3%), followed by hyperactive (25%) and mixed type (16.7%). Metabolic or respiratory acidosis at baseline was significantly associated with delirium (p = 0.030). Presence of delirium led to significant prolongation of PICU stay (p < 0.001). CONCLUSION: The emergence of delirium elicited in this study is on the lower side incomparison to previous studies. Several etiological factors for delirium are preventable and hence protocols and guidelines for management are required.

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The three Ds of geriatric psychiatry-delirium, dementia, and depression are common and challenging diagnoses among elderly. Delirium is often difficult to diagnose and is an independent risk factor for morbidity and mortality in older adults. Dementia also affects a significant number of older adults and is associated with delirium, depression, frailty, and failure to thrive. It is well known that depression too increases with increasing age. These three syndromes can exist simultaneously in the same patient, and often confer increased risk for each other, especially in the geriatric population. Early identification, classification, and differential diagnosis are important at the primary care level for the timely management of these common problems of old age. We present a case of concurrent findings and complexity in the medical literature.

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BACKGROUND: Suicide is major public health issue worldwide. The educational interventions in enhancing the knowledge, modifying the attitudes, and raising the competence levels of healthcare professionals to prevent suicides have shown positive results. However, these education programs are under-evaluated, especially in India. AIM: The aim was to evaluate the effect on suicide prevention and management-related knowledge among nursing staff, attitudes, and competence for suicidal patients and their family members. METHODS: A brief suicide educational intervention training program was prepared for the study participants. The outcomes of this study were evaluated through a single group pre-test-post-test questionnaire. RESULT: The mean age of the participants was 28.74 ± 5.73 years. Participants reported significant improvement in their attitude and knowledge about suicide after attending the training program. CONCLUSION: Empowering primary health care staff including nurses to identify, assess, manage, and refer the suicidal person should be considered as an important step in suicide prevention.

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BACKGROUND: Patients of diabetes mellitus experience psychological difficulties associated with their disease which remains unrecognized involving several states related to coping with diabetes. Diabetes distress is a distinct condition which is often mistaken for depression and is related to adverse disease outcomes. AIMS AND OBJECTIVE: To study the prevalence and predictors of diabetes distress in patients of Type 2 Diabetes mellitus (T2DM) in a tertiary care centre. MATERIALS AND METHODS: This cross-sectional study was conducted over a period of one year at Endocrine OPD of Pt. B.D. Sharma PGIMS, Rohtak, a tertiary care centre in northern India. 410 consecutive patients having T2DM attending the endocrine OPD were screened for psychiatric disorders and 189 diabetic patients with no underlying psychiatric disorders were included in the study. Their socio-demographic and relevant clinical variables were recorded. Diabetes Distress Scale (DDS) was used to measure distress due to the disease in these patients. RESULTS: It was found that the prevalence of diabetes distress was 18.0%; among them 16.1% had emotion related distress, 5.6% regimen related distress, 1.5% interpersonal related distress and 1.2% physician related diabetes distress. The major predictors for high diabetes distress scores among diabetic cases were low education level, retinopathy, neuropathy and hypertension. CONCLUSION: The present study suggests that emotion related diabetes distress was more prevalent among diabetic patients. Lower education level and the presence of diabetic complications contribute as risk factors for high diabetes distress.

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BACKGROUND: Diabetes is one of the most common chronic diseases and affects virtually every organ of the human system. Depression and anxiety is common among patients with diabetes and associated with worse diabetes outcomes. AIMS AND OBJECTIVE: To study the prevalence and predictors of depression and anxiety in patients of Type 2 diabetes mellitus (T2DM) in Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India, a tertiary care center in Northern India. MATERIALS AND METHODS: Four hundred ten consecutive patients having T2DM and 410 healthy controls matched for age and sex attending the endocrine out-patient department of a tertiary care center of Northern India were included in the study. Sociodemographic and relevant clinical variables were collected. They were evaluated for depression and anxiety using Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale respectively. RESULTS: It was found that a significantly larger proportion of diabetic patients had depression (26.3% vs. 11.2%, P = 0.001), anxiety (27.6% vs. 12.7%, P = 0.001) and comorbid depression and anxiety (21.0% vs. 7.3%, P = 0.001) as compared to healthy controls. Diabetic women had higher depression (17.1% vs. 9.3%) and anxiety (17.6% vs. 10.0%) than men. The major predictors for a severe form of depression and anxiety among T2DM cases were age, female sex, insulin therapy, retinopathy, nephropathy, and ischemic heart disease. CONCLUSION: The present findings reveal that diabetic cases had significantly higher depression and anxiety as compared to healthy controls. The risk factors for depression and anxiety were age, female sex, insulin therapy, and diabetic complications.

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Munchausen syndrome by proxy (MSBP) is emerging as a serious form of child abuse. It is an intentional production of illness in another, usually children by mothers, to assume sick role by proxy. It is poorly understood and a controversial diagnosis. Treatment is very difficult. We present a case of 9-year-old boy brought to Pt. B. D. Sharma, PGIMS, Rohtak, a tertiary care hospital in northern India by his father and paternal uncle with complaints of hematemesis since July 2012. He underwent many invasive procedures until the diagnosis of MSBP was finally considered. The examination of the blood sample confirmed the diagnosis. The child was placed under custody of his mother. The case was reported to social services, which incorporated whole family in the management.

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INTRODUCTION: The presence of depression in patients with diabetes mellitus is reported to be associated with poor glycemic control and an increased risk of diabetic complications. Treatment of depression with selective serotonin reuptake inhibitors (SSRIs) may improve glycemic control and may be beneficial for patients with comorbid depression and diabetes. AIMS AND OBJECTIVE: To study the effect of Escitalopram (SSRI) in patients with diabetes mellitus with comorbid depression and the relationship of treatment response for depression and glycemic control. RESEARCH DESIGN AND METHODS: 40 patients received open-label Escitalopram therapy for up to 12 weeks. Clinical outcome measures included Hamilton Depression rating scale (HAM-D) assessment at 3, 6, and 12 weeks. In addition, fasting and post-prandial plasma glucose level, weight and waist circumference, glycosylated hemoglobin level (HbA1C), lipid profile, renal function test and fundus examination were done before and during Escitalopram therapy. RESULTS: A significant decline in mean HAM-D scores was observed 3 weeks onwards till the end of the study during Escitalopram therapy. There was a corresponding decline in mean fasting and post-prandial plasma glucose level at 6 and 12 weeks respectively and glycosylated hemoglobin level at 12 weeks was observed. CONCLUSION: Escitalopram is effective in treating depression in patients with diabetes mellitus, and has beneficial effects on glycemic control.

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Mephentermine misuse or dependence has been rarely reported in the literature. This is surprising as mephentermine bears a close structural similarity to methamphetamine. Here we report a case of mephentermine dependence with induced psychosis. A 23-year-old professional weightlifter used to administer mephentermine (60 mg) for improving performance in tournaments. The patient became dependent on mephentermine in 2009, and his consumption increased to 100-150 mg every 2-3 days since August 2012 until his presentation in clinic in mid-October 2012. He developed psychosis and had persecutory delusions. Remission of psychosis was seen with stopping use of mephentermine and use of antipsychotic medication.

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