A cross-sectional study of correlates of real-world functioning (psychopathology, cognitive dysfunction, and resilience) in patients with Schizophrenia
Anil Kumar M Nagaraj, Anjali Prakash1, P. N. Abhiram
Department of Psychiatry, Kasturba Medical College, Manipal, 1Department of Psychiatry, St John’s Medical College, Bengaluru, Karnataka, India
Aims and Objectives: Schizophrenia is a chronic mental illness characterized by positive, negative, and cognitive symptoms that impair real-world functioning. We aimed to assess the association of psychopathology, cognitive dysfunction, and resilience with real-world functioning in schizophrenia.
Methodology: This is a cross-sectional observational study, conducted among 144 clinically stable individuals with schizophrenia. Participants were assessed with Brief Psychiatric Rating Scale- Expanded Version 4.0 (BPRS-24) and Negative Symptom Assessment-16 (NSA-16) for psychopathology. Cognitive function was assessed using Addenbrooke’s Cognitive Examination – III and Trail making Test- Parts A and B. Resilience was measured using Brief Resilience Scale, and real-world functioning with Personal and Social Performance Scale (PSP). Spearman’s correlation and multiple linear regression were used to examine associations and predictors of functional outcomes.
Results: Real-world functioning was negatively correlated with overall symptom severity (ρ = –0.655, p < 0.001) and all NSA-16 subdomains, especially affect (ρ = –0.628) and social (ρ = –0.611). Cognitive domains, particularly fluency (ρ = 0.439, p < 0.001), were positively associated with functioning. Interestingly, resilience did not significantly correlate with PSP scores. Regression analysis identified BPRS total score, affect subdomain, and fluency as significant predictors, accounting for 63.9% of the variance in PSP scores.
Discussion: Consistent with existing literature, negative and cognitive symptoms are the primary determinants of real-world functioning. While earlier literature suggested protective effects of resilience, our findings did not show a significant correlation between resilience and real-world functioning, reiterating its complex and context-dependent nature. But nicotine dependence was associated with higher resilience, supporting the self-medication hypothesis. General psychopathology was negatively correlated with PSP scores, consistent with prior reports.
Conclusion: Residual positive symptoms, affect subdomain of negative symptoms, and fluency emerged as significant predictors of functional outcomes. While resilience did not directly predict functioning, its potential mediating role warrants thorough exploration through longitudinal studies.
Key words: Cognitive deficits, negative symptoms, real-world functioning, resilience, schizophrenia
Dose-response association of selected antidepressants (sertraline, mirtazapine and venlafaxine) in depression
Archana Chauhan
AFMC, Pune, Maharashtra, India
Background: Depression affects 3.8% of the global population, projected to be the second-leading cause of global disease burden by 2030. Antidepressants have variable efficacy in treating depression. This study aims to evaluate the dose-response association of selected drugs over 8 weeks in Indian population.
Methods: This observational study included 100 drug-naïve patients diagnosed with depression (ICD-10). Patients were started on sertraline or mirtazapine or venlafaxine based on clinical judgment. The Hamilton Rating Scale for Depression (HAM-D) was used to assess depression severity and response over 8 weeks. Doses were adjusted based on clinical response.
Results: At baseline, 73% of patients had moderate depression, and 27% had severe depression. The dose was up-titrated to mean dose of 122.9mg Sertraline, 23.6mg Mirtazapine and 119.4mg Venlafaxine resulting in reduction in HAM-D scores (61%) by sertraline, followed by mirtazapine (58%) and venlafaxine (43%). No significant association between sociodemographic variables and treatment response was found.
Discussion: Indian study of 100 drug-naïve patients with depression evaluated responses to sertraline, mirtazapine and venlafaxine over 8 weeks. Sertraline and mirtazapine showed 60% symptom reduction, with doses up to 150 mg and 45 mg, respectively, producing significant outcomes. Venlafaxine yielded 43% reduction up to 120 mg. Early response was with mirtazapine, but by 8 weeks, sertraline and mirtazapine demonstrated comparable efficacy, outperforming venlafaxine. This highlights the importance of dose titration and longer treatment duration, with limitations including small sample size and lack of control for confounding factors.
Conclusion: Sertraline, mirtazapine, and venlafaxine showed significant improvements in HAM-D scores over 8 weeks, with a positive dose-response association of sertraline, mirtazapine and venlafaxine up to 150 mg, 45 mg and 187.5 mg, respectively.
Prevalence and incidence of OCD in patients receiving clozapine
Arshia Sood, Sandeep Grover
Department of Psychiatry, PGIMER, Chandigarh, India
Background: Schizophrenia is frequently associated with obsessive–compulsive symptoms (OCS) and obsessive–compulsive disorder (OCD), with prevalence rates reported between 10–64% and 7.8–29.8%, respectively. Clozapine, an effective agent for treatment-resistant schizophrenia, has been linked to both the emergence and exacerbation of OCS/OCD. Despite its clinical relevance, Indian data on the prevalence, course, and phenomenology of OCS/OCD in clozapine-treated patients remain scarce.
Aims: This study aimed to evaluate the prevalence, incidence, course, and phenomenology of OCS/OCD in patients with severe mental illness receiving clozapine.
Methods: We retrospectively reviewed the treatment records of 500 patients prescribed clozapine at a multispecialty tertiary care hospital in North India. Socio-demographic details, clinical variables, presence of OCS/OCD before and after clozapine initiation, and the course of these symptoms were extracted and analysed.
Results: Among 500 patients, 18.2% (n=91) had OCS/OCD prior to clozapine initiation, while 7.0% (n=29/409) developed de novo OCS/OCD during treatment. Overall, one-fourth (24%) of patients receiving clozapine experienced OCS/OCD. The most frequent obsessions were contamination and obsessive doubts, while compulsions mainly involved cleaning and checking rituals, both in pre-existing and de novo cases. The mean clozapine dose at onset was 288.8 mg/day, with a mean latency of 52.5 months. In de novo cases, 27.5% remitted spontaneously, 24.1% improved after dose reduction, and 48.4% responded to adjunctive SSRIs. In patients with pre-existing OCS/OCD, symptoms resolved in 57.1%, worsened in 25.3%, and decreased in 10.9% following clozapine initiation.
Conclusion: Approximately one in four clozapine-treated patients presented with OCS/OCD, with most cases predating therapy. Clozapine may also induce de novo OCS/OCD, albeit infrequently, with phenomenology similar to primary OCD. Management strategies include dose adjustment or augmentation with SSRIs. The findings emphasize the importance of systematic monitoring and individualized treatment planning in this vulnerable group.
Abuse of older people and its associated factors among older people staying in community-based old-age homes: A multicentric study
Aseem Mehra, Tanvi Kiran
Department of Psychiatry, PGIMER, Chandigarh, India
Background: Abuse of older people is a significant and emerging problem. Only a limited number of studies have evaluated abuse of older people among older people staying in community-based old age homes.
Aim: To evaluate abuse of older people among older people staying in old-age homes: a multi-centric study.
Methods: It was a cross-sectional study conducted across three different states in India. 254 older people were assessed on the Vulnerability Abuse Screen Scale, Geriatric Depression Scale-30, Generalized Anxiety Disorder-7, Montreal Cognitive Assessment Scale, EuroQOL-5D, Consensus criteria for metabolic syndrome, and DSM-5 Criteria for substance use disorder.
Results: The mean age of the participants was 74.8 years (SD = 8.3), with a mean number of years of education of 10 years. 18.1% had a presence of abuse, and the most commonly reported abuse was dependence, followed by dejection, vulnerability, and coercion. Abuse was significantly reported more frequently by females, those with voluntary admission in old-age homes, the presence of past psychiatric disorder, and the current presence of depression and anxiety disorder. Abuse among older people was significantly more in those with a higher severity of depressive symptoms, higher severity of anxiety symptoms and poor quality of life. The overall score on GDS-30 explained 21.1% of the variance of abuse of older people, overall score on GAD-7, overall score on ED VAS, gender, and history of mental illness.
Conclusion: Abuse of older people is significantly higher among older people staying in old-age homes. Older people can be empowered and protected against abuse of older people with awareness programs, providing remedial measures and increasing the accessibility of existing protective factors.
Key words: Abuse of older people, old-age homes, psychiatric disorders, quality of life
Shift from physical to digital communication and its effect on family dynamics and well-being in children with specific learning disability: A case-control study
Ayushi Dubey, Alka Subramanyam, Prajakta Patkar, Rashmi Singh
Department of Psychiatry, BYL Nair Hospital and Topiwala National Medical College, Mumbai, Maharashtra, India
Introduction: The COVID-19 pandemic profoundly transformed family communication due to increased reliance on digital media amid lockdowns and remote schooling. There is paucity of data focusing on the relationship between digital technology and family dynamics. This study examined the impact of this shift from physical to digital communication on family dynamics and well-being, comparing children diagnosed with Specific Learning Disability (SLD) to a matched control group without SLD.
Materials and Methods: A cross-sectional case-control design was used, including 61 children with SLD diagnosed as per DSM-5 criteria with 61 age- and gender-matched controls recruited from healthcare staff families. Selection criteria ensured exclusion of severe psychiatric or neurological disorders. Data collection involved a case record form detailing socio-demographics and digital device use, a semi-structured questionnaire exploring the extent and nature of internet use, and two validated scales: the Family Assessment Device (FAD) assessing seven dimensions of family functioning, and the Beach Center Family Quality of Life Scale (FQOL) measuring parental satisfaction with family well-being.
Results: Statistical analyses showed that families of children with SLD experienced significantly greater dysfunction in problem-solving, communication, and role allocation compared to controls. Emotional expression, family support, and task distribution also differed significantly, indicating that digital communication shifts may exacerbate challenges in these families. The FQOL scores revealed lower satisfaction in stress management, childcare support, social connections, and healthcare access for families with children having SLD.
Conclusion: This study highlights digital technology’s double-edged impact: while it enabled connection during pandemic constraints, excessive use correlated with reduced face-to-face interaction, emotional disengagement, and conflict, especially in vulnerable groups. The findings underscored the importance of balanced technology use and parental supervision to support healthy family dynamics. This research contributes critical understanding of digital communication’s effects on families of children with SLD, offering insights to guide interventions during ongoing digital transitions in society.
Impact of binge-watching OTT platforms on academic procrastination among MBBS students: A cross-sectional study
Ashish Yadav, Deepti M. Bhatt, Vishal Damani, Parnavi Singh
Gujarat Institute of Mental Health, Ahmedabad, Gujarat, India
Background: Over-the-Top (OTT) streaming platforms have dramatically transformed media consumption patterns, particularly among undergraduate medical students. Binge-watching behavior, characterized by watching multiple episodes or extended content continuously, has emerged as a potential factor contributing to academic procrastination.
Aim: This study aimed to examine the correlation between binge-watching behavior on OTT platforms and academic procrastination among undergraduate medical students.
Methods: A cross-sectional observational study was conducted among 506 undergraduate MBBS students across medical colleges in Ahmedabad, Gujarat, from October to December 2024. Data were collected using validated questionnaires including the Binge-Watching Questionnaire (BWQ), Academic Procrastination Scale (APS), and socio-demographic profiles. Statistical analysis was performed using IBM SPSS version 22.1.
Results: Among 506 participants, 332 (65.6%) reported engaging in binge-watching behavior. A significant positive correlation was found between binge-watching and academic procrastination (r = 0.457, p < 0.001). Binge-watchers had significantly higher mean APS scores (76.71± 15.12) compared to non-binge-watchers (66.01 ± 17.34), p < 0.001. First-year students and higher-income groups showed significantly higher binge-watching behavior (p = 0.001). Moderate binge-watching severity was most prevalent (76.2%), with mobile devices being the primary platform for content consumption (41.0%).
Conclusion: This study demonstrates a strong positive correlation between binge-watching behavior and academic procrastination among undergraduate medical students. The findings highlight the need and pathway of future studies for awareness campaigns, time management interventions, and behavioral strategies to mitigate the negative impact of excessive OTT platform usage on academic performance.
Key words: Academic procrastination, binge-watching, medical students, OTT platforms, screen time
Sexual functioning and marital quality among women with remitted bipolar I disorder
Pooja Patangi, Natarajan Varadharajan, Vikas Menon
Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
E-mail: sppooja123@gmail.com
Aims: Sexual dysfunction (SD) remains an underdiagnosed in patients with bipolar disorder (BD). We primarily aimed to assess and compare sexual functioning levels (primary outcome) between women with remitted BD I disorder and apparently healthy controls. Additionally, we aimed to compare marital quality (secondary outcome) between groups.
Methods: Between June 2024 and September 2025, using a cross-sectional design, we recruited outpatient women (18-50 years) with BD I in remission (cases) and apparently healthy non-related women (controls). Sexual functioning and marital quality were assessed using the Female Sexual Function Index (FSFI) and the Marital Quality Scale (MQS). Associations of sexual functioning with sociodemographic, clinical parameters, and marital functioning were examined using Spearman’s correlation and multiple linear regression analyses.
Results: We recruited 43 cases (mean age, 39.65±6.8 years) and 41 controls (mean age, 35.78±6.3 years). The mean duration of marriage for cases was 17.29±8.6 years, and for controls was 10.34±7.8 years. The FSFI scores were not significantly different between groups (t=-1.98, p=0.05). Marital quality scores were significantly different between groups (t=2.51, p=0.01). Univariable regression showed that FSFI was negatively associated with age (B=-0.11, p=0.31) but not associated with euthymic duration(B=0.21, p=0.16) or dose of mood stabiliser (B=0.02, p=0.91), dose of antipsychotic (B=0.24, p=0.11). Multivariable regression showed that FSFI was not associated with variables (B=44.17, p=0.138).
Discussion and Conclusion: In contrast to previous literature, we found no differences in sexual functioning between women with BD I in remission and control subjects. Future studies should involve larger and adequately powered samples to examine associations of interest.
Key words: Bipolar I disorder, female sexual functioning, India, marital quality, sexual dysfunction
Psychosocial determinants of access to offline targeted interventions among virtually active LGBTQ community in Delhi
Shruti Garg, Mahadev Singh Sen, Manoj Kumar, Rajinder K. Dhamija, Prerna Sharma
Institute of Human Behaviour and Allied Sciences, Delhi, India
Background: LGBTQ face pronounced mental health challenges driven by stigma, discrimination, and minority stress, contributing to added barriers in accessing targeted HIV interventions. This study aimed to explore psychosocial determinants affecting access to offline HIV-related services among virtually active men who have sex with men (MSM).
Methods: Employing a mixed-method, cross-sectional design, Phase 1 involved qualitative interviews with 30 MSM and their stakeholders (comprising 10 key informant interviews and five focus group discussions). Phase 2 quantitatively validated these findings using a self-developed Likert questionnaire with 150 adults.
Results: The two MSM groups had similar mean ages (24 ± 4 vs. 23 ± 4*), and most demographic parameters were matched. Skilled employment was greater among online MSM (23% vs. 7%*), and a higher proportion belonged to nuclear families (65% vs. 45%*). Social media usage was markedly higher in the online group (91% vs. 21%*). Major Offline service barriers included bureaucratic inefficiency, healthcare discrimination (57% vs. 64%*), gender identity issues, lack of safe space (68% vs. 77%*), economic insecurity, and psychological distress. Enabling factors comprised supportive NGOs, confidentiality, welcoming clinical environments, targeted education, and resource access. Both groups rated awareness programs as highly effective (84% vs. 92%*) for improving access and HIV testing. Mental health burdens were highly prevalent and closely associated with stigma and fear of disclosure (*online vs. offline).
Discussion: Need for comprehensive interventions integrating psychological care is highlighted. Offline participants reported greater difficulties, and current AIDS programs lack regular involvement of mental health professionals. Integrating psychological support and training providers within HIV services is vital to reduce stigma, boost engagement, and improve outcomes.
The demographic and clinical profile of periodic catatonia
Surabhi Gupta, Sandeep Grover
Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Background: Catatonia is a complex neuropsychiatric syndrome that may present across a spectrum of psychiatric and medical conditions. Periodic catatonia, characterized by recurring episodes of catatonia, remains understudied, with limited data available from India.
Aim: To study the demographic and clinical profile of patients with periodic catatonia.
Methods: This retrospective chart review was conducted at a tertiary care hospital in North India. Patients presenting with two or more catatonic episodes, irrespective of the underlying psychiatric diagnosis, were included. Sociodemographic details, clinical characteristics, treatment profiles, and outcomes were extracted and analyzed.
Results: A total of 77 patients with periodic catatonia were identified. The mean age was 43.6 years (SD=17.1), with a slight female predominance (57.1%). Most patients were married (61%), from urban areas (52%), and belonged to middle socioeconomic status (77%). Psychotic disorders (58.5%) were more common than affective disorders (41.5%), with schizophrenia (39%) being the most frequent diagnosis. The mean age of onset of illness was 29.7 years, and of the first catatonic episode was 35.8 years. Patients had a mean of 3.7 catatonic episodes (range 2–47), lasting on average 32.9 days. Symptom profile remained consistent across episodes in 83% of patients. Nearly half (49%) had medical comorbidities. In the most recent episode, 40% received lorazepam challenge test, with 81% showing positive response; 46% received ECT. Olanzapine and lorazepam were the most frequently prescribed psychotropics.
Conclusion: Periodic catatonia is commonly associated with schizophrenia and mood disorders. While most patients respond acutely to lorazepam and ECT, long-term management necessitates addressing the underlying psychiatric condition.
Prevalence and correlates of problem gambling in opioid use disorder in a tertiary care setting: A cross-sectional study
Tathagata Biswas, Pritiman Mishra, Chinu Patra1, Biswa Ranjan Mishra, Arpit Parmar
Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 1Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
E-mail: drtatz92@gmail.com
Background: Problem gambling (PG) frequently co-occurs with substance use disorders and may compound psychosocial and financial harms. While PG with comorbid alcohol use has been studied earlier, data among individuals with opioid use disorder (OUD), remain limited. This study aimed to estimate the prevalence of PG and identify its clinical and behavioral correlates among treatment-seeking adults with OUD.
Methods: This cross-sectional study included adult males aged 18–65 years with OUD (DSM-5 criteria) from outpatient and inpatient Psychiatry facility at a tertiary care center in eastern India. The sociodemographics, clinical variables and substance use history, including injecting drug use (IDU) and high-risk sexual behavior (HRSB) were assessed. Gambling measures included the South Oaks Gambling Screen (SOGS). Descriptive statistics and multivariable logistic regression were used to estimate PG prevalence and evaluate independent correlates in the sample.
Results: PG was present in 32.8% (41/125) of the total sample. Compared with those without PG, affected individuals were more often urban residents (92.7% vs 75.0%; p=0.018) and had higher rates of alcohol (51.2% vs 22.6%; p<0.001) and cannabis (82.9% vs 53.6%; p<0.001) use disorders. They also had longer opioid use duration (60.4 vs 27.1 months; p=0.004) and past history of HRSB (61.0% vs 31.0%; p<0.001). However, differences in IDU prevalence were not statistically significant (58.5% vs 46.4%; p=0.204). In multivariable analysis, comorbid cannabis use disorder remained independently associated with PG (adjusted OR≈9.1; p=0.021), whereas longer opioid duration showed a trend-level association (p≈0.10).
Conclusion: Problem gambling is common among treatment-seeking adults with OUD, highlighting the need for routine screening within addiction services. Integrated care should include assessment and intervention for co-occurring cannabis use and associated risk behaviors to reduce overall clinical burden.
Buprenorphine versus methadone: One-year retention in a community-based OAT program in India
Vinit Patel1,2, Gurveen Kaur2, Ravindra Rao2, Roshan Bhad2
1Department of Psychiatry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, 2National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences, New Delhi, India
E-mail: drrvrao@gmail.com
Aims and Objectives: Opioid agonist treatment (OAT) is central to managing opioid use disorder (OUD), yet retention remains a major challenge. While global studies often show superior retention with methadone, most evidence comes from high-income countries and controlled settings, with limited data from low- and middle-income countries (LMICs). This study aimed to compare one-year treatment retention between buprenorphine and methadone in a community-based program in India, and to identify predictors of long-term retention.
Methodology: This retrospective cohort study used electronic clinical records of individuals initiating OAT between January 1 and December 31, 2022, at a community-based clinic in an urban resettlement colony in Delhi, India. Participants (≥18 years, ICD-10 diagnosis of opioid dependence syndrome, received at least one OAT dose, no crossover between medications) were followed for one year from treatment initiation. Exclusions included initiation beyond one week of registration, receipt of naltrexone, or incomplete records. Retention was defined as receipt of at least one OAT dose in the preceding seven days. Predictors of retention were assessed using univariate and multivariable logistic regression, with covariates including sociodemographic variables, OAT dose (morphine milligram equivalents), adherence, and self-reported craving and withdrawal at last follow-up.
Results: Among 256 eligible participants (buprenorphine: 103; methadone: 153), one-year retention was significantly higher with buprenorphine than methadone (50.5% vs. 32.7%, p=0.004). Univariate analysis showed associations with buprenorphine use, current employment, skilled occupation, higher OAT dose, and lower craving and withdrawal. In the multivariable model, buprenorphine treatment [AOR=1.91, 95% CI: 1.05–3.52], skilled occupation [AOR=2.17, 95% CI: 1.14–4.31], and higher OAT dose [AOR=1.011, 95% CI: 1.004–1.017] remained significant.
Discussion and Conclusion: In a real-world Indian cohort, buprenorphine was associated with significantly higher one-year retention than methadone. Higher treatment retention was independently associated with buprenorphine use, skilled occupation, and higher dose of OAT medicine.
Assessment of correlates of seasonality in patients presenting with depressive disorder at tertiary care hospital in North India
Kajol, Gurvinder Pal Singh1, Jitender Aneja1, Bharat Udey1, Jawahar Singh1
Rori Manorog Hospital, Sirsa, Haryana, 1Department of Psychiatry, AIIMS, Bathinda, Punjab, India
E-mail: ruhs.kajol@gmail.com
Background: In a previous analysis from the same dataset, we reported that approximately one in five patients with Major Depressive Disorder (MDD) in North India exhibited seasonal patterns of illness. Building upon these findings, the present study aimed to explore clinical and socio-demographic correlates of seasonality, comparing patients with Seasonal Affective Disorder (SAD), subsyndromal SAD (s-SAD), and non-seasonal depression.
Methods: This cross-sectional study recruited 403 patients with DSM-5 diagnosed MDD (aged 18–65 years) from a tertiary care psychiatry department. Patients with major psychiatric or severe medical comorbidities were excluded. Assessments included socio-demographic and clinical profile proformas, Hamilton Depression Rating Scale (HAMD), and the Seasonal Pattern Assessment Questionnaire (SPAQ). Statistical comparisons were made between SAD, s-SAD, and non-SAD groups.
Results: Of the total sample, 15.63% met criteria for SAD and 6.45% for s-SAD. Seasonality was significantly more frequent among patients with recurrent depressive disorder compared to single-episode depression (p<0.001). SAD patients had a longer total duration of illness, higher number of episodes, and longer remission periods than non-SAD patients. While overall HAMD scores did not differ significantly, SAD and s-SAD groups reported moderate-to-marked seasonal changes in mood, sleep, appetite, energy, and weight. The most common months of symptom fluctuation were May–July (summer) and November–January (winter), whereas non-SAD patients reported minimal variation across seasons.
Conclusion: Seasonality in MDD is not only prevalent but also associated with distinctive clinical features, particularly in recurrent depression. These findings, extending our earlier work, emphasize the importance of routinely assessing seasonality in depressive disorders to inform tailored treatment strategies, including light therapy and season-specific interventions.
Key words: Major depressive disorder, seasonality, seasonal affective disorder, seasonal pattern assessment questionnaire
Adjunctive cariprazine in patients with drug-resistant obsessive compulsive disorder: A randomised, double-blind, placebo-controlled study
Nisha Karar
Central Institute of Psychiatry, Ranchi, Jharkhand, India
Background: Obsessive compulsive disorder (OCD) is a chronic neuropsychiatric disorder. However, a substantial proportion of individuals with OCD fail to attain sufficient benefit with conventional treatment using serotonin reuptake inhibitors. Cariprazine, a partial agonist at D3/D2 receptors, has been tried recently as an augmenting agent in drug-resistant OCD. However, a randomised controlled trial (RCT) is lacking.
Aim: To investigate the efficacy of adjunctive Cariprazine in drug-resistant OCD via a double-blind RCT.
Methods: A total of 40 drug-resistant OCD patients were randomly assigned to treatment with either Cariprazine 1.5 mg or Placebo for 6 weeks, along with treatment as usual. The Yale Brown Obsessive Compulsive Scale (YBOCS), Hamilton Depression Rating Scale (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAM-A), Interleukin-1β, and Tumor Necrosis Factor-α were measured at baseline, 2nd, 4th, and 6th weeks of the trial.
Results: The baseline characteristics were comparable between the groups. There was a significant time–treatment interaction effect on YBOCS Total score (p=0.02), YBOCS Obsession (p=0.02), and YBOCS Compulsion subscale scores (p=0.01) between the groups. The improvement is correlated with the difference in between-groups Serum TNF-α levels over time (p=0.04). No major adverse effects were recorded, and the frequency of side effects was not significantly different between the groups.
Conclusion: Adjunctive Cariprazine improved OC symptoms by the 2nd week, as evidenced by a greater reduction in total YBOCS score, with a statistically significant reduction in YBOCS Obsession and Compulsion subscale scores. The improvement persisted till the end of 6 weeks.
Key words: Augmentation, cariprazine, drug-resistant, obsessive compulsive disorder, Yale Brown Obsessive Compulsive Scale
Exploring cultural and psychosocial determinants of help-seeking and treatment adherence in perinatal mental disorders
Pratibha Gehlawat, Anadrika Debbarma, Nisha Prajapati, Rashmita Saha
Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, Delhi, India
Aim and Objective: To explore the cultural and psychosocial determinants influencing help-seeking behaviour and treatment adherence among women with perinatal mental disorders.
Methodology: The study was conducted in Perinatal Mental Health Clinic run weekly at a neuropsychiatric institute in northern India. It was a qualitative exploratory study design. In-depth interviews based on DSM-5 Cultural Formulation Interview (CFI) framework were conducted which were audio-recorded and transcribed. Women aged 18–45 years during perinatal period, diagnosed with common perinatal mental disorders as per DSM‐5, and were under treatment for at least three months, who were able to understand Hindi or English were included. Women with severe mental disorders and acute psychiatric crises requiring inpatient admission were excluded. 30 participants were recruited using purposive sampling. Key caregivers were also included. Thematic analysis of data was performed using Atlas.ti version 8.4.5.
Results: A total of 12 themes including inductive and deductive were identified. Some of the important inductive themes included “Stigma and shame surrounding motherhood and mental illness”, “pressure to be ideal mother”, “struggle between traditional roles and personal aspirations”, “feeling misunderstood in clinical encounters”, “seeking help for sake of baby’s well-being” and “fear of disclosure of symptoms leading to separation of child”. The implicit themes such as cultural understanding of the problem and cultural factors affecting help‐seeking showed role of family, cultural expectations and societal pressures in shaping the problem.
Discussion: Present study findings highlight stigma, shame and societal expectations as major barriers to perinatal mental health care. Poor understanding of perinatal mental illness as transient distress of pregnancy was identified as the most common determinant of poor help seeking and treatment adherence.
Conclusion: Cultural competence helps pregnant and partum women with mental health disorders feel validated, encouraging help-seeking and treatment adherence.
Unveiling the triad of stigma, discrimination, and social cognition in first-episode schizophrenia: A cross-sectional study from North India
Raj Laxmi, Swapnajeet Sahoo, Sandeep Grover
Department of Psychiatry, PGIMER, Chandigarh, India
Background: There is limited data on the impact of social cognitive deficits on perception of internalized stigma and discrimination faced by patients with First-Episode Schizophrenia (FES). Specifically, impairments in the ability to understand and interpret social cues contribute to an increased internalization of stigmatizing beliefs. These social cognitive difficulties not only hinder social functioning but also influence how affected individuals experience stigma on a personal level.
Aim: To evaluate the association between stigma, discrimination, and social cognition in patients with FES, currently in clinical remission.
Methodology: Eighty-one patients of FES (duration of illness ≤5 years) in clinical remission were assessed on the Internalized Stigma of Mental Illness Scale (ISMI), the Everyday Discrimination Scale (EDS) and the Social cognition rating tools in Indian setting (SOCRATIS).
Results: Mean age of the study sample was 26.62 (SD: 6.68) years. Males outnumbered females (64.2 % versus 35.8%). There was no significant correlation between stigma and social cognition. However, when those with and without stigma were compared, patients with stigma in the stereotype endorsement domain of ISMI exhibited more deficits in the First and Second Order Theory of Mind (p = 0.024) domain. Higher level of discrimination was significantly associated with poorer faux pas performance (p = 0.027).
Conclusion: The findings of the present study suggest that some of the deficits in the social cognition adversely affect the perception of stigma among patients with FES. Accordingly, addressing social cognition deficits can help in reduction of perception of internalized stigma and consequently improve the social integration.
Key words: Discrimination, first episode schizophrenia, social cognition, stigma
A prospective, interventional study to compare the efficacy of standard RTMS protocol targeting bilateral DLPFC, right DLPFC and supplementary motor area (SMA) in patients with treatment resistant OCD (TR-OCD)
Smrity Shailly Bagde
NKP Salve Institute of Medical Sciences, Nagpur, Maharashtra, India
Background: RTMS has emerged as a promising therapeutic option for OCD and stimulation of effective target site is of utmost importance. The bilateral DLPFC is theorized to provide a balanced modulation and SMA has gained interest recently. Studies have shown efficacy of each target individually, but lacks evidence to establish a hierarchy of efficacy.
Aim: 1. To compare the efficacy of RTMS targeting the bilateral DLPFC, right DLPFC, and SMA in patients with TR-OCD. 2. To assess the response and remission rates in these patients.
Methods: Institutional Ethics committee approval was taken. 30 patients diagnosed with OCD as per DSM 5 guidelines with Y-BOCS score ≥20 were selected. 10 patients were randomly allocated in each 3 groups for 30 sessions over 6 weeks. 1. Bilateral DLPFC (HF (10 Hz) Left DLPFC and LF (1 Hz) Right DLPFC). 2. LF (1 Hz) Right DLPFC. 3. LF (1 Hz) SMA.
Results and Discussion: Mean YBOCS score at Baseline (B/L DLPFC- 31.2+/-3.1, RT DLPFC – 32.3+/-2.8, SMA- 32.6+/-3.3) and at week 4,8,12 were calculated. Week 12 scores (7.01+/-1.6, 12.1+/-2.3, 6.2+/-1.4 respectively). Mean changes were compared via post hoc analysis. Mean difference was found to be significant between B/L DLPFC and RT DLPFC, SMA and RT DLPFC (p value - <0.001). Response and remission rates were assessed by chi square test. B/L DLPFC AND SMA group patients noted significant response rate and remission (p value < 0.001).
Conclusion: The study suggest stimulation of all 3 sites are highly efficacious, but in patients with TR-OCD, RTMS targeting SMA and B/L DLPFC are more effective for achieving sustained remission.
Keywords: OCD, remission, RTMS
Lived experiences of caregivers of patients with first episode psychosis: A qualitative study from India
Swapnajeet Sahoo, Neha Sharma, Sandeep Grover, Ritu Nehra
Department of Psychiatry, PGIMER, Chandigarh, India
Background: Caregivers of patients with First Episode Psychosis (FEP) experience a range of psychosocial challenges and coping responses, yet their perspectives remain underexplored in the Indian sociocultural context.
Aim: To explore the lived experiences of caregivers of patients with FEP, focusing on their understanding of illness, explanatory models, caregiving challenges, stigma, family impact, and future concerns.
Methodology: This qualitative, cross-sectional study recruited 20 caregivers of patients with FEP in clinical remission through purposive sampling from a tertiary care centre in North India. Inclusion criteria required caregivers to have lived with and provided care for the patient for at least one year. After informed consent, in-depth semi-structured interviews were conducted, audio-recorded, transcribed, and translated into English. Thematic analysis was employed using both inductive and deductive coding until saturation was achieved. Triangulation and inter-rater reliability (κ value estimated on 12 transcripts) ensured rigor.
Results: Caregivers had a mean age of 50.4 years (SD = 11.9); and most were parents. Thematic analysis generated six themes and eighteen sub-themes: (1) Understanding of Illness—variable awareness; many misattributed symptoms to stress or depression; (2) Causation Beliefs—stress from academics and life events predominated, with some citing supernatural causes; (3) Treatment Challenges—reported ineffective initial treatments (n=12), multiple consultations (n=8), financial burden (n=3), COVID-19 disruptions (n=4), and visits to faith-healers (n=4); (4) Family Dynamics—caregiving caused widespread stress (n=14), depressive symptoms in caregivers (n=3), and strained relationships (n=7); (5) Stigma Experiences—while 11 denied overt stigma, 9 concealed illness to avoid discrimination, and 4 reported community stigma; (6) Future Concerns—six caregivers anticipated lifelong medication, while six expressed uncertainty about illness course and independence.
Conclusion: Caregivers of patients with FEP in India face substantial emotional, financial, and social challenges, often compounded by limited illness awareness and cultural explanatory models. Addressing treatment barriers, strengthening psychoeducation, reducing stigma, and providing culturally sensitive family-based interventions are crucial for improving caregiver well-being and patient outcomes.
Key words: Caregivers, first episode psychosis, India, lived experiences, qualitative
Comparison of delusions and hallucinations between substance-induced psychotic disorders and schizophrenia
Tahoora Ali
Institute of Human Behaviour and Allied Sciences, New Delhi, India
Background: Delusions and hallucinations are hallmark features of psychosis, yet their phenomenology differs between schizophrenia and substance-induced psychotic disorders (SIPD). This study compared the qualitative aspects of these symptoms across the two conditions using validated measures.
Methods: A cross-sectional design was employed with SIPD (n = 30) and schizophrenia (n = 30) groups recruited from a tertiary psychiatric hospital. The Brief Psychiatric Rating Scale (BPRS) and the Psychotic Symptom Rating Scales (PSYRATS) were administered. Data were analyzed using SPSS, applying independent t-tests and chi-square analyses.
Results: Delusional distress was significantly higher in SIPD (M = 14.6, SD = 3.2) compared to schizophrenia (M = 11.1, SD = 2.8), t(58) = 4.21, p < .001. SIPD also demonstrated greater delusional preoccupation (p = .003). However, schizophrenia showed more organized delusional content (χ²(1, N = 60) = 6.87, p = .009). Hallucinations occurred more frequently in schizophrenia (83%) than SIPD (47%), χ²(1, N = 60) = 9.64, p = .002. Within SIPD, alcohol- and stimulant-related cases showed higher hallucinatory prevalence compared to cannabis users (p < .05). Importantly, hallucinations in SIPD were associated with greater fear and distress (M = 15.8, SD = 4.0) than in schizophrenia (M = 12.3, SD = 3.5), t(48) = 3.01, p = .004.
Conclusion: Findings suggest SIPD involves more distressing and intrusive delusions, while schizophrenia exhibits greater delusional organization and hallucinatory frequency. Symptom profiling may aid differential diagnosis and guide targeted interventions.
The invisible subtype: A nationwide snapshot of atypical depression and MAOI underuse in Indian psychiatry
Vipul Janardan, Manoj Kumar
Department of Psychiatry, Institute of Human Behaviour and Allied Sciences Hospital, New Delhi, India
Introduction: Atypical depression, characterized by unique symptoms such as mood reactivity and specific somatic features (e.g., hypersomnia, weight gain, interpersonal rejection sensitivity), has been extensively studied in Western contexts. However, there is a paucity of literature addressing its prevalence and treatment patterns in India, particularly concerning the use of monoamine oxidase inhibitors (MAOIs).
Aim: To assess the clinical awareness, diagnostic frequency, and treatment practices regarding atypical depression among Indian psychiatrists, with a specific focus on the use and prescribing patterns of monoamine oxidase inhibitors (MAOIs).
Methods: An online survey was conducted using Google Forms and distributed via WhatsApp groups targeting Indian psychiatrists with more than 10 years of clinical experience. The survey comprised two questions: the number of atypical depression cases diagnosed and the use of MAOIs in treatment. A total of 108 psychiatrists from across India participated voluntarily.
Results: The survey revealed that 40% of psychiatrists had never diagnosed a case of atypical depression, 32% had diagnosed one case, and 20% had diagnosed two cases. Only 8% had diagnosed more than two cases. Regarding MAOI usage, 85% of participants had never prescribed these medications, with only 14.8% prescribing them for atypical depression.
Discussion: The results highlight a significant underdiagnosis of atypical depression and limited use of MAOIs among Indian psychiatrists, likely due to cultural, genetic, or sociodemographic differences and potential gaps in training or diagnostic criteria. These findings underscore the need for a systematic large-scale study to assess the true prevalence of atypical depression and improve training for psychiatrists to enhance recognition and treatment.
Conclusion: Atypical depression remains underrecognized in India, with low rates of diagnosis and limited use of MAOIs. This study emphasizes the need for further research and targeted educational initiatives to bridge the gaps in diagnosis and treatment practices.