Background:Alcohol and opiates are among the most addictive substances posing significant public health problems due to the biopsychosocial impact that they have on individuals. Research shows that majority of abstinent alcohol and/or opioid dependence subjects relapse within 1 year. It has also been estimated that 26–36 million people worldwide abuse opiates, with exceptionally high-relapse rates. The purpose of this study was to compare the sociodemographic factors and correlates relapse in alcohol dependence and opioid dependence.Methodology:This research uses a cross-sectional comparative study design with a sample size of 60 drawn from a population of clinically diagnosed patients of alcohol dependence (n = 30) or opioid dependence (n = 30) and seeking treatment for relapse. In addition to collecting sociodemographic data, other factors such as craving, affect, self-efficacy, and expressed emotions were measured using standardized instruments including brief substance craving scale, Bradburn affect balance scale, drug avoidance and self-efficacy scale and family emotional involvement, and conflict scale. The data were statistically analyzed.Results:Disparity in sociodemographic factors was seen in both the groups with opioid group being more likely to be single, unemployed, belonging to lower socioeconomic status, and having a criminal record (P = 0.025). Among factors associated with relapse, the opioid group scored significantly higher on craving, perceived criticism (P = 0.0001), and lower on self-efficacy (P = 0.016). Most common reason cited for relapse in both the groups was desire for positive mood.Conclusion:This study highlights the role of social determinants in drug dependence and relapse. Relapse was found to be a complex multifactorial phenomenon. Despite differences in presentation, somewhat similar relapse mechanisms were seen in both groups.

Context:There is a paucity of published telepsychiatry results in India.Aims:This study was conducted to assess the feasibility of asynchronous telepsychiatry and to study the referral patterns.Settings and Design:This study was conducted in the telemedicine unit of a tertiary care center and design was retrospective analysis of 94 cases, which were diagnosed and treated by telepsychiatry.Materials and Methods:All 94 patients who were referred between January 2007 and August 2013 for telepsychiatry consultations were retrospectively analyzed to assess the referral pattern and feasibility.Statistical Analysis Used:Comparisons between demographic parameters and psychiatric diagnosis was done using Chi-square test.Results:In 89 out of 94 (95%) patients it was possible to make a definitive diagnosis and recommend appropriate treatment only on the basis of data received from the primary care physician by telepsychiatry. This indicates the feasibility of telepsychiatry. The most common problems for which referrals were made included schizophrenia and other psychotic disorders, mood disorders and substance related disorders.Conclusions:This study demonstrates the feasibility of Asynchronous telepsychiatry. Additional Indian studies should be conducted to build the evidence base for the best use of asynchronous telepsychiatry.

Background: Alcohol use disorder is a common and challenging problem in India. In various studies the prevalence of co-morbid psychopathologies ranges from 15-70% including depression & anxiety disorders. Coping mechanisms of individual play vital role in case of developing alcohol dependence and various psychopathologies. A complex interaction of psychopathologies, coping skills, and alcohol use can influence the outcome of alcohol dependence. This study was undertaken with the aim of studying coping mechanism along with anxiety, depressive symptoms and their correlation in patients of alcohol dependence.Methods: This was a cross sectional study conducted in a tertiary government hospital. Institutional ethics committee approval obtained. 152 patients with the diagnosis of alcohol dependence (DSM IV TR) were screened for inclusion and exclusion criteria, out of which 60 patients were enrolled after taking written informed consent. Following scales were used for the study, mechanisms of coping scale (MOCS), Hamilton anxiety rating scale (HAM-A), Montgomery-Asberg depression rating scale (MADRS).Results: 32 patients had HAM-A score >17 suggestive of anxiety, similarly 40 patients had MADRS score >7 indicating depression. Problem focussed coping mechanism such as problem solving is associated with better outcome in terms of lesser anxiety and later age of first drink as well as developing dependence. Passivity, which is an emotion focussed coping mechanism, is associated with earlier first drink and higher depression score in patient suggesting poor outcome.Conclusions: Coping skills training should be incorporated in abstinence focused programs. Co-morbid psychopathologies like anxiety and depression are common in alcohol dependence individuals and thus, screening for these symptoms is essential for early interventions and better outcomes.

Psychiatry and crime are linked in certain ways. On one hand, we have criminal offenders with serious psychopathology; and on the other hand, we have psychiatric patients who may commit criminal offences during the influence of a psychiatric disorder. The psychiatrist in practice has to come in contact with the criminal justice system at some point of time in his career. Forensic psychiatry under whose realm these issues reside is a branch yet underdeveloped in India. The present paper reviews the inter-relationship between crime and psychiatry and the factors involved therein.

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Personality disorders has been a neglected subset of all psychiatric disorders. Borderline Personality Disorder (BPD) and Antisocial Personality Disorder (ASPD) are the two most complex disorders of personality noted. There is a dearth of Indian literature on the same. This study aims at comparing the psychopathology in BPD and ASPD while studying alexithymia in these populations. A wide variety of psychopathology was noted in both these disorders. Anger hostility was more common in ASPD, while somatization and obsessive compulsiveness with anxiety was commoner in the BPD group. Both groups showed an equal amount of interpersonal stressors. Substance abuse was seen in all patients with ASPD while depression was more common in the BPD group. This study though limited in its subjects highlights the need to explore and research this neglected psychiatric population in diverse settings and longitudinally across time. KEY WORD-Borderline, Antisocial. Personality disorder.

BACKGROUND Family burden of caregiver of patients with mental illness accounts for nearly half of the global burden of diseases. Considering the importance of the issue, the present study therefore has been undertaken, to better understand the experiences of family caregiver for patients with schizophrenia in comparison with bipolar disorders (BPAD). METHODS A hospital based, cross-sectional comparative study was conducted in Masina Hospital Dept. of Psychiatry. A total of 200 primary caregivers, 100 each of patients suffering from Schizophrenia and BPAD was included. The phenomena and severity of perceived burden, psychopathology of family members in both the groups were studied and compared. Burden of caregivers was assessed by using BAS scale. Psychopathology of the caregivers assessed by HDRS and HARS. Appropriate statistical tests were applied, and data was analysed using the Statistical Package for Social Sciences (SPSS) Version 16 and Primer of Biostatistics software. RESULTS According to BAS Score, burden perceived by caregivers of patients suffering from schizophrenia and bipolar disorder (p=0.67) was equal and in mild to moderate range. (p= 0.001). Clinically diagnosable depression and anxiety were also in mild to moderate range in both groups. Depressive symptoms (schizophrenia group n-63% & BPAD group n-77%) were more common than anxiety symptoms (schizophrenia group n=27% & BPAD group n=24%) in both groups. Caregivers of bipolar group (n-77) experienced depressive symptoms more than caregivers of schizophrenia (n=63) group. Majority of caregivers perceived moderate anxiety. CONCLUSIONS This study demonstrates that degree of caregiver burden was the same in both the disorders. Caregivers experience considerable amount of distress as a result of the care giving role, and are vulnerable to developing minor psychiatric disorders such as anxiety and depression. Mild to moderate depression appears to be more commonly present. Caregivers of BPAD are more at risk of developing psychopathology. Anxiety seems to be an early predictor of perceived burden, therefore can be helpful in aiming at early interventional strategies to reduce burden.