This brief clinical review summarizes the literature on sleep paralysis most relevant to clinicians. Sleep paralysis is a condition where the sufferer awakens to rapid eye movement sleep based atonia, combined with conscious awareness. This is a frightening event accompanied by vivid, waking dreams and hallucinations. Sleep paralysis occurring independent of narcolepsy and other medical conditions is termed isolated sleep paralysis. Though rare in clinical practice, the unusual nature of the condition and a lack of training during medical residency and graduate education leads to fewer cases being detected. This paper looks at the prevalence, risk factors, diagnosis and management of sleep paralysis. The management consists of both pharmacological and psychotherapeutic interventions that need clear guidelines, empirical support and larger randomized controlled trials.

Dementias are the most common type of neurodegenerative disorders. Behavioral disturbances are seen in 50-80% of patients suffering from these disorders. Sexually inappropriate behaviors are not as common as other behaviors seen in dementia but may be seen in 7-30% subjects. These behaviors cause a lot of distress to all those who are affected along with shame and embarrassment. Sexual behaviors in dementia lie on a spectrum that may range from mild or benign to severe. There are no rigorous clinical studies for the treatment of these behaviors and there is no fixed classification for the types of behavior either. There is sparse data that suggest efficacy for some commonly used treatment modalities in dementia. In this chapter, we review the various aspects of these behaviors, their types and the available treatment for the same.

Introduction: Internet has been easily accessible to students living in urban areas. With its unprecedented development and many benefits, it also leads to Internet addiction (IA) among people. Though IA is a disorder in itself, there can be other disorders associated with it as well. One such association of IA is with depression. Objective: The aim of this paper is to show a potential relationship between internet addiction and depression among students belonging to the urban setting. Materials and Methods: The research sample consisted of 228 students aged between 11-27 doing their schooling or graduation. To assess the study, a self-administered questionnaire consisting of three parts was given to them. The first part comprised of socio-demographic information and pattern of internet usage. Second part consisted assessment of internet addiction using Young’s 20 item Internet addiction test (IAT) and the third module comprised of Birleson’s depression self-rating scale (DSRS) questionnaire. Results: The 228 study participants were classified based on their scores obtained on IAT and DSRS scales. They were divided into two class labels: Depression Yes and Depression No. 99 were classified to the “YES Depression class” and 129 were classified to the “No Depression class” and overall classification accuracy achieved was 85.5%. Conclusion: Students get addicted to the internet due to its easy availability and accessibility. The current study showed that this addiction is associated with depression. It also showed that internet addiction and depression is more prevalent above the age of 19.

Introduction: Suicide attempt is a self-injurious behavior with a non-fatal outcome. An insight into psychosocial factors and methods used can be used to device effective preventive strategies. Aims: The aim is to study the psycho-social factors and to find the frequency of different methods used in attempted suicides. Materials and Methods: This study is a descriptive, cross-sectional, hospital-based analysis of attempted suicides. 44 consecutive attempted suicides admitted in the emergency ward and referred to the Psychiatry department were taken into the study. A Semi-structured intake Performa consisting of socio-demographic data, detailed history of current suicide attempt, and access to means were noted. MINI (Mini International Neuropsychiatric Interview), Hamilton Depression rating scale, Beck’s suicide intent scale, and Barratt’s impulsiveness scale were used to screen the patients. SPSS 20 was used for statistical analysis. Results: In the study it was found that majority of people who attempted suicide were of young age, females, married, fully employed, belonged to class IV socioeconomic status and attempts were made equally during day and night. The most common method was drug-overdose followed by poisoning with Organo-Phosphorous compounds. Mental illness was found only in 34% individuals, of which most common was depression. And one-fourth of the individuals had contact with General Practitioner within one month of the suicide attempt. Conclusion: The need for psycho-education and social skills training in adolescents and young adults is implicated in the study. Awareness among the general physicians about suicide prevention would help in bringing down the number of attempts as would strict control of, over the counter drugs and storage of organo-phosphorous compounds.

Introduction: Suicide is a serious public health problem. Many factors are known to influence suicide. Much has been studied about the influence of media on suicide attempters. Less studied is the effect of media from a rural background. Aim: To study the profile of suicide attempters from a rural background and the role of media. Materials and Methods: This study was undertaken in a General Hospital Psychiatry unit attached to Government Medical College. Total of 189 medically stable suicide attempters with the rural background was included in the study. The profile of the participants influenced by media was studied. SPSS version 20.0, was used for descriptive and inferential statistics. Results: One hundred and eighty-nine participants were included. Based on the type of influence, three groups were formed [influenced by media (television) (n=37) / influence by other attempters (n=57) / own inner feelings (n=95)] who differed significantly with respect to age (χ²= 4.134, p=0.018) and type of attempt (χ²= 6.619, p=0.037). Regression analysis showed the presence of adjustment disorder predicting the person to be influenced by internal feelings to attempt suicide. Conclusion: One in five was influenced by media. Majority of the participants were influenced by their own internal feelings. Influence of media was higher in the younger age group. There is a dire need to spread mental health awareness to prevent suicide attempts/suicides and to improve appropriate help-seeking behavior. Television was the common source of influence, hence using this media would help to create awareness in rural population.

Introduction: Depression is associated with increased physical co-morbid conditions. The results of previous studies on the relationship between symptoms of depression and metabolic syndrome are weak. Objectives: Hence this study was designed to assess the frequency of metabolic syndrome in unipolar depressive patients and its association with the symptoms of unipolar depression. Materials and Methods: A total of 64 patients with unipolar depression, diagnosed according to ICD 10 guidelines were included consecutively. Spearman’s correlation was performed to find the association. Results: 23.4% of unipolar depression patients had metabolic syndrome. Our study did not reveal any significant association between the symptoms of unipolar depression and metabolic syndrome. Conclusion: Prevalence of metabolic syndrome in depression is low and symptoms of depression are not associated with metabolic syndrome.

Introduction: A bidirectional relationship between depression and diabetes is well established. WHO predicts India will lead in the number of persons with diabetes by 2030. Therefore, factors that can alter the glycemic control (evaluated by glycated hemoglobin levels-HbA1c) needs to be targeted to promote health in diabetes, hence the need for this study. Objectives: To assess the correlation of depression and anxiety with HbA1c in recent-onset Type II Diabetes Mellitus (T2DM). Materials and Methods: A cross-sectional study was conducted in the outpatient of an urban tertiary care hospital on 94 consenting patients with an established diagnosis of Type 2 DM for >1year and<10years duration without complications. Hospital Anxiety and Depression scale (HADS) and Mini International Neuropsychiatric Interview (MINI) plus were used to evaluate sub-syndromal and syndromal depressive and anxiety symptoms. Recent HbA1c and blood glucose levels were noted. Results: In this sample HADS found 43% (n=40) with anxiety and 33% (n=31) with depressive symptoms. 80% (n=75) sample had abnormal HbA1c (>7) (mean=8.53±1.68). A trend towards positive correlation was noted between HbA1c and total depressive (r=0.1194/p=0.2518) and anxiety (r=0.0006/p= 0.9953) symptoms, however, not statistically significant. 26 of these individuals qualified for the syndromal diagnosis of anxiety spectrum and depression on MINI plus. No correlation found with Obesity and HADS. Conclusion: In this study in patients with recent onset diabetes, no correlation was found between HbA1c levels and depressive or anxiety symptoms. However, it was noted that subclinical symptoms of anxiety and depression were more common than the syndromal diagnosis.

Introduction: Major depressive disorder is widely prevalent in the general population and depression in geriatric patients is quite common. Increasing geriatric population in the country coupled with lack of awareness of depression and therefore lack of adequate care may lead to the suffering of the elderly people. We attempted to study depression in geriatric patients and the associated risk factors. Aims: Our aim was to study characteristics and associated risk factors of depression in geriatric patients attending the psychiatry outpatient department (OPD) for the first time. Materials and Methods: A total of 100 geriatric patients aged above 60 years, attending psychiatric OPD for the first time were enrolled in the study. Informed consent of patients who agreed to participate in the study was taken and socio-demographic data collected. A 30 item Geriatric depression scale was used to assess the severity of depression. Cognitive functions were screened by using the Mini-mental status examination (MMSE) in those suspected of neuro-cognitive problems. We excluded patients having psychotic and substance use disorders and having cognitive impairment interfering with giving information. Results: Headache and sleep disturbances were the most common presenting symptoms in geriatric patients with depression. The two non-modifiable risk factors found to be significantly associated with depression in the geriatric population were older age group and female gender. However, the potentially modifiable risk factors for depression in the geriatric population were low socioeconomic status, loss of a spouse, living alone, chronic co-morbidities, cognitive impairment, bereavement and restricted activities of daily living (ADL). Conclusion: Geriatric patients attending psychiatry OPD primarily for their somatic symptoms should be evaluated for depression, as a high prevalence rate of depression was found among them. Better awareness regarding depression will help for early identification and treatment.

Introduction: Psoriasis is a recurring, cutaneous- articular, chronic inflammatory disease, resulting from immune and proliferative changes that affect the skin and mucosa. The worldwide incidence is 1-3% and the majority of the patients also have emotional difficulties like anxiety, depression, and sexual dysfunction. These issues along with the extent of body surface area affected have an impact on the quality of life, in particular, the sexual life. Aim: To assess the sexual function of males with psoriasis and to study the relation of different variables with sexual functioning. Materials and Methods: A cross-sectional study of 4 months duration was carried out among male patients with psoriasis who attended the dermatology department at a tertiary care hospital in Andhra Pradesh. Male Patients with any form of psoriasis aged between 25-55yrs diagnosed by the dermatologist and willing to give written informed consent were subjected to study tools like Psoriasis area and severity index (PASI), International Index of Erectile Function scale (IIEF) and Hamilton Depression Rating Scale (HAM-D). Results: 85% prevalence was noted for both depression and sexual dysfunction among patients with Psoriasis and very significant correlations i.e. p<0.005 was observed with all the study variables. Conclusion: High prevalence of sexual dysfunction and depressive disorder was noted in the study subjects and the result of this study gives an idea about the importance of screening for sexual and psychological disorders in patients suffering from psoriasis.

Introduction: A substantial decline in cognitive function has been found to be associated with the diagnoses of cardiovascular diseases in the general population. Aims and Objective: To compare the cognitive dysfunctions in patients with heart disease admitted in the intensive cardiac care unit (ICCU) with that of the patients admitted in general medical wards with heart diseases. Materials and Methods: The study is a cross-sectional study done on a total of 30 patients admitted to ICCU and 30 patients with heart disease admitted in general medical ward of a tertiary care hospital. The tools used were a semi-structured proforma, Hospital anxiety-depression scale, Standardized Mini-Mental Status Examination, and Brief Cognitive Rating Scale. Statistical tests used were Student ‘t’ test and Chi-Square test using SPSS software. Results: Comparison of the two groups illustrates that patients with heart disease admitted in ICCU had greater levels of anxiety (p= 0.00).These two groups differ statistically significantly in all five items of the BCRS-concentration, recent memory, remote memory, orientation, functioning with p= 0.00 in each item and with respect to Orientation to time (p= 0.00), orientation to city (p=0.01) and orientation to floor of building (p=0.00), in Registration. (p= 0.03), Spelling WORLD backward (p=0.00), Recall (p= 0.026), Identifying Wristwatch. (p= 0.039), repeat “No Ifs, and or buts”. (p= 0.0004), Reading. (p= 0.009) using SMMSE. Conclusion: The study has shown that heart disease patients admitted in ICCU have more cognitive impairment compared to those admitted in general medical ward and that early intervention can potentially revert the condition to improve the quality of life in heart disease patients.

Introduction: Despite availability of adequate treatment, premature termination of treatment or lost to follow-up is great concern in patients with psychoactive substance use. This creates a hindrance in getting the favorable outcomes, indirectly adding up to the increased burden of the disease. This study focuses in assessing the socio-demographic and clinical variables associated with drop-outs in these patients which can guide the clinicians and health care delivery system to make required efforts in preventing these drop-outs. Aims and Objectives: To study the pattern including socio-demographic and clinical profile of drop-out patients with mental and behavioral disorder due to psychoactive substance use. Materials and Methods: Patients attending the Psychiatry Walk-In-Clinic of tertiary care teaching hospital of North India from June 2018 to July 2018 and diagnosed with ‘Mental and behavior Disorder due to psychoactive substance use’ (F10-19) as per ICD-10 were enrolled in the study. Socio-demographic and clinical variables of these patient were recorded using the Departmental walk-in Performa. Patient who didn’t come for follow-up visit till 4 weeks after first contact were considered drop-out. Data was analyzed for factors related to dropouts. Results: A total of 1553 patients registered in walk-in-clinic during a period of 2 months (June- July 2018), in which 175 patients were diagnosed with Mental and behavior disorder due to psychoactive substance use. Out of 175, 106 were drop-outs (60%). Socio-demographic and Clinical profile of drop-out patients revealed that 57% were of age group 20-40 years, 98% were Male, 75% were married, 70% had income more than 7000 rupees per month, 54% belonged to joint family, 49% were of opioid dependence, followed by alcohol dependence (31%) and 54% had no h/o of previous treatment. Conclusion: It can be concluded from the current study that patients with opioid use, employed and without any medical or surgical co-morbidity are more likely to drop-out after the first contact.

Ofloxacin is a commonly used fluoroquinolone antibiotic in adults as well as children. It is generally safe and well tolerated though rare neurological and psychiatric adverse reactions have been reported with Ofloxacin. We report a case of a 6 years old child who developed hallucinations after being started on Ofloxacin and which resolved on discontinuation of the drug.

Skin rashes have been reported after the start of various antipsychotic drugs in the scientific literature. It is important that psychiatrists be aware of antipsychotic-induced skin reactions in patients on antipsychotic medication which can be an uncommon yet possible occurrence. Patients with psychiatric problems may be prone to skin reactions and may not report the same as they may not be aware of the same. We herewith report a case of skin reaction with Olanzapine in a patient with schizophrenia.

Introduction: Bowel incontinence due to antipsychotic drugs is rarely seen as an adverse effect. The mechanism of it is poorly understood, though alpha antagonism is believed to play an important role, along with secondary antihistaminergic action. It is usually a self-limiting side effect though in rare cases, needs to be managed. Here we report a case of bowel incontinence associated with the use of Risperidone. Case Description: A 35-year-old Mr. A was treated with Risperidone 2mg for control of psychotic symptoms. The patient reported bowel incontinence on the fourth day of inpatient care. Other probable causes for the same were ruled out. Resolution of incontinence occurred after discontinuation of Risperidone. Discussion: In our case, the use of risperidone is a possible reason for bowel incontinence. However, not many case reports have been previously documented wherein a patient developed bowel incontinence with an antipsychotic drug. Conclusion: Risperidone associated bowel incontinence is an uncommon manifestation. Hence, clinicians should be aware of such unusual adverse event associated with Risperidone use.

Psychiatric morbidity is high in children with unexplained chronic pain and thus needs to be assessed and treated. Unexplained pain symbolizes emotional distress and conflicts in children. The most common somatic symptoms are headache, abdominal pain, and musculoskeletal symptoms. Aim: The aim of this case series is to qualitatively analyze the responses obtained on projective tests and intervention strategies employed in children with unexplained pain symptoms. Materials and Methods: Our cases included a total of 12 children and adolescents who were referred to us from the pediatric department for complaints of unexplained pain symptoms for a period of at least 6 months. The investigations done for these children were reportedly normal. After the initial rapport and initial intake, the children underwent projective testing. The projective tests used were Children apperception test, Thematic Apperception Test and Sentence Completion test. Results: The findings observed were conflict with primary caregivers, over-involvement and overly critical parents, sibling rivalry and intrapersonal conflicts. Intervention strategies primarily focused on psychoeducation, addressing secondary gain, parents session to address their relationship with the child and cognitive behavioral strategies as applicable to the case. Conclusion: Children with unexplained pain symptoms require detailed history taking and psychological evaluation. Projective tests facilitate conflict identification and early intervention to address psychological factors.

Dr. Narendra Wig (1930– 2018) is amongst the foremost psychiatrists of India. Dr. Wig has been variously described as a world-renowned mental health expert, a compassionate psychiatrist, a teacher par excellence, and an excellent, humane person. He had his medical education MBBS and MD (Medicine) from KG Medical College, Lucknow. He held a double diploma in Psychological Medicine, one from England and another from Scotland. He was a fellow of India’s prestigious National Academy of Medical Science. In 1991, the Royal College of Psychiatrists, London, honored him with the highest award of the Honorary Fellowship of the College, and he was the only Indian psychiatrist to be thus honored. In 1997, Dr. Wig was designated as Professor Emeritus, Postgraduate Institute of Medical Education and Research, Chandigarh.