Background: There is a paucity of studies exploring the role of ketamine as augmenting agent to conventional antidepressants. Materials and methods: Sixty patients with major depressive disorder (MDD) were randomized to 4 weeks’ double-blind treatment with escitalopram 10 mg/day + single-dose intravenous (IV) ketamine (0.5 mg/kg over 40 minutes) or escitalopram 10 mg/day + placebo (0.9% IV saline). Depressive symptoms were measured using the Montgomery–Asberg depression rating scale (MADRS), adverse effects were measured with the brief psychiatric rating scale (BPRS), young mania rating scale (YMRS), and clinician administered dissociative states scale (CADSS). Patients were assessed at baseline, 4, 24, and 48 hours and 7 days and 28 days. Response (50% MADRS score reduction) was the primary outcome. Results: The MADRS scores showed significant reduction in the group receiving ketamine as compared to group receiving placebo at 4, 24, and 48 hours, 1 week, and 28 days (p < 0.001). By 4 weeks, compared to escitalopram + placebo-treated patients, more of escitalopram + ketamine-treated patients responded (80% vs 20%) and remitted (21.67% vs 0%). Rapid response was evident at 4 hours in ketamine group as compared to placebo (36.67% vs 0%). Both CADSS and YMRS scores were significantly higher (p < 0.001) in the ketamine group as compared to the placebo group at 4 hours but not at 24 and 48 hours and 7 and 28 days. Conclusion: Single-dose IV ketamine as an add-on to 10 mg/day escitalopram is efficacious, resulting in more rapid and robust response over 4 weeks. Dissociative and mania-like symptoms emerging post-infusion are mild and transient, not warranting treatment discontinuation. Further research into the role of ketamine augmentation in MDD is required for its clinical applicability.

Introduction: The pathway to care in psychiatry consists of a detailed and systematic description of sources of care used by the patients before seeking help from mental health professionals (MHPs). Aim: To qualitatively evaluate the experiences of patients during various pathways taken by them through thematic analysis. Materials and methods: This study was conducted at the Department of Psychiatry of Pondicherry Institute of Medical Sciences (PIMS), Puducherry. Those who had more than two encounters in the quantitative study were invited to participate. Interviews were conducted ensuring privacy, comfort, and confidentiality. Themes were analyzed using inductive coding method from the in-depth interviews. Results: Themes related to participant's understanding about the illness, first symptom that triggered initiation, nature of encounters, reasons attributed by patients and healers, and remedies done were found. Some of the remedies prescribed by the traditional healers (THs) were violent and horrific. Conclusion: This study throws light into the understanding of the pathways taken by psychiatric patients in South India and the need to promote awareness among general public including the magicoreligious healers.

Background: Internet addiction increases the stress level and interferes with the academic performance and other activities in college students. The objective was to examine the relation of internet use characteristics and perceived stress in internet addiction among first-year medical students. Materials and methods: This was a cross-sectional and observational study of 200 first-year students of medical college, Jamnagar. Patterns of internet use and socioeducational data were collected. Internet addiction test (IAT) was used to assess the internet addiction. Perceived stress scale (PSS) was utilized to assess the stress level. The data were analyzed using appropriate statistics. Results: Out of total 172 participants, 5.73% of students had internet addiction. More than half of the students with internet addiction were using internet for 5 years or more and almost everywhere, spending more money, and using multiple gadgets for internet. More than 85% of the students with internet addiction did not perform any daily exercise/sports, were spending more than 2 hours in a day, and had high levels of perceived stress. The distribution of total duration of internet use, time and money spent on internet, gadgets used for internet, perceived stress, and internet addiction was also found to be statistically significant using multiple logistic regression analysis. Conclusion: Internet usage with multiple gadgets and spending more time, for longer duration (>5 years), were correlates of internet addiction in college students. Students with internet addiction perceived high level of stress.

Background: Behavioral and psychological symptoms of dementia (BPSD) is defined as “symptoms of disturbed perception, thought content, mood or behavior that frequently occur in patients with dementia.” Behavioral and psychological symptoms of dementia is associated with significant caregiver burden, early institutionalization, and rapid cognitive decline. The worldwide prevalence of dementia is 5–7%; whereas in India, it is reported to be 0.8–4%. Alzheimer's dementia amounts to 60% of the total prevalence of dementia. We aim to study the neuroimaging correlates of BPSD in Alzheimer's dementia. Objective: To study the correlation between BPSD with white matter changes on neuroimaging in Alzheimer's dementia. Materials and methods: It is a cross-sectional study with a sample size of 30 patients. The magnetic resonance imaging (MRI) changes were seen using volumetric analysis and white matter hyperintensity change using Fazekas scale, global cortical atrophy (GCA) score, medial temporal atrophy (MTA) score, and KOEDAM scale. Results: It was found that clinical dementia rating (CDR) scale has positive correlation with Fazekas, GCA, and KOEDAM. Addenbrooke's cognitive examination (ACE-3) has correlation with GCA. On neuropsychiatric inventory (NPI) questionnaire, depression followed by nighttime behavior were the most common BPSD symptoms. Sociodemographic factors such as age >65 years, middle socioeconomic status (SES) population, and urban population have higher mean neuropsychiatric inventory-frequency and severity (NPI-F*S) scores. Conclusion: Our study here in concordance with other studies worldwide gives a clue about the role of neuroimaging biomarkers in understanding BPSD in terms of its neuroimaging correlates and builds the scope of future studies in this domain. The study sheds light on the common presentation of BPSD, which adds to our knowledge in clinical assessment of Alzheimer's disease (AD) patients. Finally, it also adds to our understanding of the role of sociodemographic factors in predicting the at risk population.

Background: Mental illness is a public health issue all over the world. The morbidity pattern in private clinics differs significantly from general hospitals. Private psychiatric clinics provide help for large number of our population, but they have seldom been evaluated systematically. It has been observed that many patients particularly from upper socioeconomic background prefer visiting a private clinic. Hence, the study is planned in this direction. The study was aimed to assess the morbidity pattern of psychiatric patients attending a private psychiatric clinic. Aim: To analyze the clinical and sociodemographic characteristics of the clients attending the private clinic and to study the pattern of follow-up. Materials and methods: All records from February 1, 2019 to April 30, 2019 were analyzed. This is a descriptive study. Results and conclusion: A total of 1,020 new patients visited the clinic in this period. We found that mental disorders comprise a wide variety of disorders—mainly psychotic, mood disorders, and neurotic disorders. They affect the most productive age groups, almost equally affect both the genders, and there was a slight preponderance of rural patients.

Though cyproheptadine is commonly used for treatment of different allergic conditions, the molecule is effective in different psychiatric conditions mainly due to antiserotonin property. Cyproheptadine can be used in different psychiatric conditions like functional gastrointestinal disorders, serotonin syndrome, akathisia, tardive dyskinesia, anorexia nervosa, stimulant-induced weight loss, antidepressant induced sexual dysfunction, neuropsychiatric adverse effects associated with efavirenz therapy in HIV positive patients, migraine type headache, augmentation agent in schizophrenia. As the molecule is not very costly, its use can help in improving psychiatric practice in developing nations.

Dementia is a complex neuropsychiatric disorder that needs medical and nonpharmacological approaches for its long-term management. This review aims at providing an overview of the various nonpharmacological strategies employed in the long-term management of dementia. The paper looks at various treatment approaches like occupational therapy, methods to improve daily living, alternative medicine approaches, and various innovative approaches like animal-assisted and pet therapy. The paper also outlines various forms of psychotherapy and cognitive enhancement methods that may be used for patients and their caregivers alike. Certain general guidelines for the nonpharmacological management of dementia at home are suggested, which shall enhance the quality of life of patients with dementia.

The global burden of depression is estimated over 300 million, which is equivalent to 4.4% of the world's population. However, it is reported that only 50% of patients receive some form of treatment and most individuals receiving conventional pharmacotherapy fail to achieve and sustain remission. Treatment-resistant depression (TRD) is defined as failure to achieve remission with two or more adequate antidepressants over a sufficient period of time. Treatment-resistant depression is estimated to occur in 10–30% of patients with major depression, and these patients need a variety of treatment strategies employed. Advances in genetic epidemiology have spurred research investigating the role genetics play in the pathophysiology of depression. Pharmacogenetic testing identifies mutations related to altered expression and functions of genes associated with antidepressant response. For this reason, genetic variants are considered theoretically optimal biomarkers to provide personalized antidepressant treatments and to reduce the proportion of patients who develop TRD. This review aims to understand the genetic mechanisms that contribute to the problem of TRD and the hurdles to its treatment in the context of the Indian population. We focus on the authors’ clinical experience in parallel with relevant research articles over the last two decades.

Preschool onset of obsessive-compulsive disorder (OCD) is rare with limited studies on it and with multiple diagnostic and treatment quandaries. We report a case of 5-year-old girl who had obsessive-compulsive symptoms since 4 years of age. She was diagnosed based on Diagnostic and Statistical Manual of Mental Disorders, 5th edition criteria after eliminating other potential diagnoses. She showed good response to a combination of parent-assisted exposure and response prevention therapy and fluoxetine. This case brings into focus the distress associated with very early onset of OCD and discussion of differential diagnoses and treatment options for it.

Body dysmorphic disorder (BDD) is a relatively common disorder that consists of a distressing or impairing preoccupation with imagined or slight defects in appearance. It is important to recognize and appropriately treat BDD, as this disorder is associated with marked impairment in psychosocial functioning, notably poor quality of life and high suicidality rates. Herewith, we present a case of 44-year-old single unmarried male with chronic duration of preoccupation with imagined bodily defect with significant sociooccupational functioning. The patient was treated with multiple psychotropics, cognitive behavioral therapy, and a trial of electroconvulsive therapy (ECT). The response to treatment was almost negligible. The focus of discussion would be the presentation and treatment protocol followed in this resistant case.

To highlight the familial influence in a patient presenting bipolar variant of postpartum psychosis (PP). Postpartum psychosis although less common than other postpartum psychiatric disorders is of immense significance in view of the course of the illness and impairment. Women with bipolar disorder or schizoaffective disorder have been reported to have >50% risk for another episode of PP. Postpartum psychosis affected 74% of mothers with bipolar disorder and a first-degree relative who had PP, compared with only 30% of bipolar women without any family history of PP. There is a strong familial component associated with the illness. Mrs. S, 24-year-old housewife, married for 5 years, 10th std, from Puducherry, brought by the mother to our OPD with complaints of sleep disturbance, irritability, anger outburst over trivial issues, and suspiciousness for past 15 days. Stressor patient gave birth to a child 15 days back following which she developed sleep disturbances, decreased self-care, neglecting the child, suspiciousness that people are talking ill about her, and that her husband had left her permanently, with a past history revealing similar illness in the past during the first childbirth 3 years ago, which resolved within 10 days of treatment. Familial aggregation of the illness will be presented in detail and treatment options will be discussed.

Moyamoya disease is a rare disorder where there is a stenosis of the internal carotid arteries and its proximal branches. The disorder has variable presentations with neurological, cognitive and depressive features. The disorder may also be seen secondary to peri-infectious and neurological sequel. We present herewith a case of a 14-year-old girl with tuberculous meningitis and ventriculoperitoneal (VP) shunting having depressive features that was diagnosed on evaluation to have moyamoya disorder.

Anticholinergics such as trihexyphenidyl are widely prescribed for the prophylaxis and treatment of antipsychotic-induced extrapyramidal symptoms. Although prescribed commonly with the typical antipsychotics, they may also be prescribed to counteract the extrapyramidal side effects of atypical antipsychotics rarely. These drugs may sometimes cause euphoria as a side effect. We report a case of a 29-year-old male suffering from schizophrenia who developed features of hypersexuality on starting trihexyphenidyl, which resolved on its discontinuation only to re-emerge on re-challenging the patient with the same drug.

Attenuated psychosis syndrome is an entity that has recently been recognized in diagnostic and statistical manual of mental disorders-5th edition (DSM-5) as a condition for further study. It is a condition in which the patient experiences psychotic-like symptoms but it does not fulfill the criteria for a full-blown psychosis. We hereby present a possible case of attenuated psychosis in a 30-year-old female and discuss its implications in diagnosis and management.