Understanding of psychopathology of mental disorder is evolving, particularly with availability of newer insight from the field of genetics, epigenetics, social, and environmental pathology. It is now becoming clear how biological factors are contributing to development of an illness in the face of a number of psychosocial factors. Resilience is a psychobiological factor which determines individual's response to adverse life events. Resilience is a human capacity to adapt swiftly and successfully to stressful/traumatic events and manage to revert to a positive state. It is fundamental for growth of positive psychology which deals with satisfaction, adaptability, contentment, and optimism in people's life. Of late, there has been a paradigm shift in the understanding of resilience in context of stress risk vulnerability dimension. It is a neurobiological construct with significant neurobehavioral and emotional features which plays important role in deconstructing mechanism of biopsychosocial model of mental disorders. Resilience is a protective factor against development of mental disorder and a risk factor for a number of clinical conditions, e.g. suicide. Available information from scientific studies points out that resilience is modifiable factor which opens up avenues for a number of newer psychosocial as well as biological therapies. Early identification of vulnerable candidates and effectiveness of resilience-based intervention may offer more clarity in possibility of prevention. Future research may be crucial for preventive psychiatry. In this study, we aim to examine whether resilience is a psychopathological construct for mental disorder.

Background & objectives:Limited data are available on prescription patterns of the antidepressants from India. We studied antidepressants’ prescription pattern from five geographically distant tertiary psychiatric care centers of the India.Method:In this cross-sectional study, all patients who attended outpatients department or were admitted in the psychiatry wards at Lucknow, Chandigarh, Tiruvalla, Mumbai and Guwahati on a fixed day, who were using or had been prescribed antidepressant medications, were included. The data were collected on a unified research protocol.Results:A total of 312 patients were included. Mean age was 39±14.28 yr and 149 (47.76%) were females, 277 (87.5%) were outpatients. Among the patients receiving antidepressants, 150 (48.1%) were of diagnoses other than depression. Diabetes mellitus 18 (5.78%) was the most common co-morbid medical illness. A total of 194 (62.2%) patients were using selective serotonin reuptake inhibitors (SSRIs) with escitalopram 114 (36.53%) being the most common antidepressant used. Overall, 272 (87.18%) patients were using newer antidepressants. Thirty (9.62%) were prescribed more than one antidepressant; 159 (50.96%) patients were prescribed hypnotic or sedative medications with clonazepam being the most common (n=116; 37.18%).Interpretation & conclusions:About half of the patients with diagnoses other than depression were prescribed antidepressants. SSRIs were the most common group and escitalopram was the most common medication used. Concomitant use of two antidepressants was infrequent. Hypnotic and sedatives were frequently prescribed along with antidepressants.

Purpose India’s Mental Healthcare Act 2017 provides a right to mental healthcare, revises admission and review procedures, effectively decriminalises suicide and has strong non-discrimination measures, among other provisions. The purpose of this paper is to examine Indian mental health professionals’ views of these changes as they relate to stigma and inclusion of the mentally ill. Design/methodology/approach The authors held nine focus groups in three Indian states, involving 61 mental health professionals including 56 psychiatrists. Findings Several themes relating to stigma and inclusion emerged: stigma is ubiquitous and results in social exclusion; stigma might be increased rather than remedied by certain regulations in the 2017 Act; stigma is not adequately dealt with in the legislation; stigma might discourage people from making “advance directives”; and there is a crucial relationship between stigma and education. Practical implications Implementation of India’s 2017 Act needs to be accompanied by adequate service resourcing and extensive education, including public education. This has commenced but needs substantial resources in order to fulfil the Act’s potential. Social implications India’s mental health legislation governs the mental healthcare of 1.3bn people, one sixth of the planet’s population; seeking to use law to diminish stigma and enhance inclusion in such a large country sets a strong example for other nations. Originality/value This is the first study of stigma and inclusion since India’s 2017 Act was commenced and it highlights both the potential and the challenges of such ambitious rights-based legislation.

An 18-year-old, single, unemployed male was brought by his mother with chief complaints of repeated falls and headache since the past one month, decreased self care since six days, angryabusive behaviour since two days. The patient was a known case of seizure disorder and intellectual impairment. His last seizure episode was a month prior to presentation. The patient was born preterm at seven months and was kept in an incubator and given multiple blood transfusions 4-5 days after birth (details of which were unknown). The patient was apparently alright till the age of three years when he started having episodes of loss of consciousness associated with frothing from mouth for which he was taken to a hospital and diagnosed as a case of seizure disorder and started on treatment (sodium phenytoin). The patient dropped out of school at 5 th standard as he continued to have episodes of seizures and academic difficulties. The patient had difficulty in calculation and needed assistance in activities of daily living. The patient used to do odd jobs like working as helper in shop or sometimes as daily wage laborer to earn for himself.A month prior to presentation, he started having sudden onset episodes of generalized headache which were severe, continuous and sometimes associated with non-projectile vomiting. Headache did not respond to medications given by the family physician and the patient was brought to our hospital and suspected to have a Viral encephalopathy and started on by the medical team on intravenous mannitol, dexamethasone, phenytoin, ceftriaxone, vancomycin and acyclovir. Magnetic Resonance Imaging (MRI) study of the brain revealed inferior cerebellar vermian hypoplasia with fourth ventricle seen communicating with cisterna magna through a keyhole defect suggestive of Dandy Walker variant [Table/ Fig-1,2].The patient improved symptomatically on the above treatment and was discharged after two weeks with advice to continue oral medication like sodium phenytoin 100 mg thrice a day, ondansetron 4 mg twice a day, pantoprazole 40 mg once a day, calcium supplements and Carbamezapine 200 mg thrice a day.The patient was maintained on same and after about a month, without any apparent reasons, he started showing altered behaviour in form of angry-abusive behaviour towards his mother and others.He showed decreased self care and stopped bathing. He had difficulty in eating food by self and would not allow his mother to AbSTRACTDandy Walker Syndrome (DWS) is a congenital malformation with brain abnormalities, intellectual disabilities, epilepsy and visible structural changes in particular brain structures. We present here a case of psychosis in an 18-year-old male with DWS, epilepsy and intellectual disability. The purpose of this paper is to discuss the clinically relevant issues, psychopharmacological issues, neuropsychiatric manifestations and consultation liaison issues involved.

The aim of the present study was to compare different features of Non-Suicidal Self-Injury (NSSI) in India and Belgium. We also explored whether the strength of the association between NSSI and disturbances in identity formation—a risk factor that can increase vulnerability to NSSI—was similar in young adults from India and Belgium. Data regarding NSSI and identity formation were collected from 182 young adults in India (56% females, mean age = 21.5 years, SD = 3.70, range = 17–38 years). The Belgian data used for matching were derived from four existing datasets. Of the 182 Indian cases, 138 cases could be matched with the Belgian sample on age, gender, and lifetime prevalence of NSSI. Lifetime prevalence of NSSI in the Indian sample was found to be around 21.4%, with higher prevalence in females than in males. Comparison of features of NSSI in India and Belgium indicated that the age of onset of NSSI was higher in the Indian sample (around 17 years) than the Belgian sample (around 15 years). Additionally, self-bruising behavior was more commonly reported in India and scratching/cutting was more often reported in Belgium. Finally, the Belgian sample reported intra-personal functions of NSSI more often than the Indian sample. Moderation analysis indicated that the associations between NSSI and identity confusion/integration were stronger in the Belgian sample compared to the Indian sample. Higher self-knowledge was protective against NSSI in both the Indian and the Belgian sample.

Objective:Various studies have shown the effectiveness of risperidone and fluoxetine in the management of behavioral problems in autism.Aim:The purpose of this study was to compare these two drugs in the management of behavioral problems in autism.Materials and Methods:Forty children with autism were divided into 2 groups in a 16-week open trial that compared these two drugs. Parents rated the children using the Aberrant Behavior Checklist (ABC) and the Conners′ Parent Rating Scale – Revised (CPRS-R). The author rated the children using the Children's Psychiatric Rating Scale and Clinical Global Impression (CGI) Scale.Results:The risperidone group showed significant improvement in areas like irritability and hyperactivity, while the fluoxetine group showed significant improvement in speech deviance, social withdrawal and stereotypy. When the two drugs were compared, fluoxetine showed greater improvement in stereotypy, while both drugs showed improvement on the general autism scale; and on anger, hyperactivity and irritability scales.Conclusions:In this open trial, both drugs were well tolerated and appeared to be beneficial in the treatment of common behavioral problems in children with autism. Further controlled and double-blind studies in larger samples are warranted.

Background:India's Mental Healthcare Act, 2017 (MHCA) greatly restricts the use of electroconvulsive therapy (ECT) in minors and bans unmodified ECT. Indian psychiatrists have raised concerns that these measures may deprive certain patients of life-saving treatment. This study describes the perspectives of Indian psychiatrists on how ECT is dealt with in the legislation.Methods:We conducted nine focus groups in three Indian states. We explored the positive and negative implications of the MHCA and discussed its implementation, especially in relation to ECT.Results:Many of the themes and concerns commonly discussed in relation to ECT in other jurisdictions are readily apparent among Indian psychiatrists, although perspectives on specific issues remain heterogeneous. The one area of near-universal agreement is Indian psychiatrists' affirmation of the effectiveness of ECT. We identified three main areas of current concern: the MHCA's ban on unmodified ECT, ECT in minors, and ECT in the acute phase. Two broad additional themes also emerged: resource limitations and the impact of nonmedical models of mental health. We identified a need for greater education about the MHCA among all stakeholders.Conclusion:Core concerns about ECT in India's new legislation relate, in part, to medical decisions apparently being taken out of the hands of psychiatrists and change being driven by theoretical perspectives that do not reflect “ground realities.” Although the MHCA offers significant opportunities, failure to resource its ambitious changes will greatly limit the use of ECT in India.

Advances in information and communication technology have facilitated the development of online psychotherapy. This form of psychotherapy would provide the developing world with better access to professional mental healthcare services. At the same time, it is prudent to carefully consider the various ethical, legal and regulatory issues involved in online psychotherapy. This paper highlights the major ethical issues involved in the use of online psychotherapy, whether conducted via e-mail, chat rooms or interactive video, and identifies practical solutions for the ethical dilemmas that exist. Many authors and organisations have expressed their opinions on the subject, but no consensus has evolved. The advice offered to psychologists is mostly skewed and the scarcity of literature available to those considering expanding their practice to include online psychotherapy is certainly a source of vexation. While reviewing the existing literature, this paper seeks to describe and discuss the major ethical issues in this area, particularly in India, but many of these issues will be equally applicable to any developing world settings.