Treatment resistance to what is often deemed the last line of schizophrenia treatment, clozapine, is a burgeoning problem in psychiatric practice, with estimates of clozapine resistance standing at 40–70% of the treated population. This paper, a comprehensive review of available literature, looks at augmentation strategies to clozapine for such patients, with pharmacological and nonpharmacological modalities considered and reviewed. With a preponderance of open-label trials and case reports, our conclusion is that more research in this field via randomized clinical trials is crucial. Every case of clozapine resistance should be managed in an evidence-based and multidisciplinary manner, with augmentation only used once optimal dosage and duration of clozapine monotherapy is reached, and the psychosocial environment is optimized.

A doodle is a simple drawing that is usually made to pass the time during a boring meeting, classroom lecture, or a prolonged telephonic conversation. Almost everyone has seen a doodle somewhere and many people have made such drawings. Doodling may not be of much interest to the general public as it is perceived to be a sign of disinterest, inattentiveness, or reverie. However, the act of doodling is of enduring interest to scientists as they believe that doodling research might actually reveal significant insights about the functioning of the subconscious mind. The widely held misconception about doodling as being just a way to ease one's boredom is all set to change since the findings of some recent researchers have shown that doodling might actually aid one's memory and recall performance. We hope that this review will instigate further research into this hitherto uncharted domain so that the real connotation of this seemingly mundane act can be decisively established.

Context: Intimate partner violence (IPV) is a major public health problem because of its detrimental effects on the physical and mental health of the victim. It is well-established that alcohol increases the occurrence and severity of violence between the partners. Aims: To find the prevalence and predictors of IPV in patients with alcohol use disorder (AUD). Settings and Design: This descriptive cross-sectional study was carried out at a De-addiction Centre of a Tertiary Government Hospital in New Delhi. Subjects and Methods: Thirty consecutive male patients were screened using International Classification of Diseases-10^th Revision criteria for alcohol dependence syndrome. Their spouses were assessed using abusive behavior inventory for identifying physical, sexual, and emotional abuse. Statistical Analysis: Data were analyzed using descriptive statistics, multiple regression analysis, and Chi-square test. Results: Overall 6 months prevalence of IPV was 90%. Prevalence was 90% for physical and psychological abuse and 76.7% for sexual abuse. Physical abuse score ranged from 1 to 4.5 (mean 2.38, standard deviation [SD] 1.01). Psychological abuse score ranged from 1 to 4.71 (mean 2.64, SD 1.01). Sexual abuse score ranged from 1 to 4 (mean 2.11, SD 0.92). Total IPV score ranged from 1 to 4.4 (mean of 2.5, SD 0.94). Education of patient and spouse were significant predictors of overall abuse. While patient's education and family history of alcohol use significantly predicted physical abuse, spouse's education predicted psychological abuse. The incidence of abuse (any type) was also significantly associated with the joint family type. Conclusion: Study shows high IPV among spouses of AUD patients. There is a need to screen IPV in AUD patients so that adequate support could be provided to affected women.

Background and Aims: Suicide attempt is a complex human behavior with multiple determinants. Literature suggests toward abdominal pain as a risk factor for a suicide attempt, but such patients need to be characterized further. This retrospective study aimed to compare individuals with abdominal pain as the reason of suicide attempt to those reporting other reasons for such attempt. Methods: This retrospective chart review-based case-control study was conducted among individuals registered at the crisis intervention clinic of a Tertiary Care Hospital in South India. Information was extracted from the records using a structured profroma. Characteristics of those with abdominal pain as the reason of suicide attempt were compared with age- and gender-matched controls. Results: Of 427 persons registered in the clinic in the period, abdominal pain was the stated reason for the attempt in 37 (8.7% of the sample). Suicide attempters whose stated reason for attempted suicide as abdominal pain had lower education (P = 0.042), were more likely to suffer from physical illness (P < 0.001), were more likely to have a recent visit to a health care professional (P = 0.047), were less likely to give hint prior to attempt (P = 0.010), and had lesser stressful life events compared to the controls (P = 0.024). Conclusions: There seem to be certain differences between suicide attempters who report abdominal pain versus other causes for a suicide attempt.

Background: Children and spouses of alcohol-dependent parents are at higher risk of developing substance abuse, emotional, behavioral, and mental health disorders at all stages of development leading into adulthood. Studies on the impact of alcohol use in children and spouse have been poorly studied. Aims: The aim of this study is to study the general health of the wife, children and adolescents of a family with paternal alcohol use and to assess the personal, family, social, occupational and educational environment of families with paternal alcohol use. Subjects and Methods: Cross-sectional analytical study in the inpatient unit of the Department of Psychiatry, Indira Gandhi Medical College and Research Institute. Participants were selected using inclusion and exclusion criteria and informed consent was obtained for all participants. International Classification of Diseases (ICD-10) diagnosis was used to diagnose alcohol dependence in the father. Sociodemographic proforma, General Health Questionnaire (GHQ), World Health Organization Quality of Life-Bref (WHOQOL-BREF) version were used to collect clinical data of the children and spouse. SPSS version 13 was used to analyze descriptive statistics and mean scores on the GHQ and WHOQOL-BREF scale. Results: Mean GHQ scores were highest in spouses (32.92), children between 12–15 years (20.34) and 16–20 years (25.01) years age group. QOL scores were low among spouses and children across all age groups. Conclusions: Physical, psychological health, well-being and QOL are significantly impacted in families where the father is alcohol dependent. Spouses were more severely affected than children.

Background: The top two contributors to the worldwide burden of disease are predicted to be ischemic heart disease (IHD) and major depression. Patients with established IHD are at risk to develop depression. Major depression is common among patients recovering from myocardial infarction (MI). As depression can worsen the prognosis of cardiac patients, it might be possible to improve the prognosis by treating the depression with antidepressants. Aim: The index study aimed to find the prevalence of depressive disorder in adult patients with MI admitted to the cardiology unit and to examine the outcome as regards to the effect and safety of escitalopram as per the treatment regime routinely followed for the treatment of depression in such patients. Methods: One hundred consecutive patients with an established diagnosis of MI admitted to the Department of Cardiology constituted the study sample. Patients who qualified for the major depressive disorder were then treated with escitalopram. Results: The overall prevalence of depression in patients with MI is 22%. The study highlights that depression in the post-MI period is common and responds well to antidepressant treatment. Escitalopram could be an effective and safe antidepressant for the treatment of depression in patients with MI. Conclusion: The study highlights that depression in post MI period is common and escitalopram seems to be an effective and safe antidepressant for the treatment of depression in MI patients.

Objectives: This study aimed to evaluate the prescription pattern of inpatients admitted in the psychiatric unit of a tertiary care hospital at the time of discharge from the inpatient setting. Material and Methods: In this retrospective chart review data of 496 patients admitted in the psychiatric unit of a tertiary care hospital in northern India diagnosed with an International Classification of Diseases-10 diagnosis of psychotic, affective and neurotic disorder were extracted and analyzed. Results: In all diagnostic groups, olanzapine was the most commonly prescribed antipsychotic followed by risperidone. Very few patients (8.8%) received typical antipsychotics. Venlafaxine was the most commonly prescribed antidepressant; other frequently prescribed antidepressants were fluoxetine, amitriptyline, and sertraline. Among the mood stabilizers, prescription of valproate exceeded that of lithium. In all the groups, more than half of the patients were prescribed benzodiazepines, clonazepam being the most commonly prescribed agent, followed by lorazepam. The mean numbers of psychotropic medications were highest in the bipolar disorder group. Very few patients received the combination of drugs belonging to the same class i.e.,, receiving two antidepressants or two antipsychotics. Conclusion: Olanzapine, venlafaxine, valproate and clonazepam are the most commonly prescribed antipsychotic, antidepressants, mood stabilizers and benzodiazepines, respectively.

Cannabis is the most commonly used illicit drug worldwide including India. The role of Cannabis in the causation of psychiatric disorders, especially psychosis remains debatable. Cannabis use has been reported to present with symptoms similar to those of schizophrenia and bipolar affective disorder. The distinction between Cannabis-induced psychoses and primary psychotic disorder is important from management perspective as it would determine the need and duration of antipsychotic medications, as well as relative focus on the management of substance use. At times, however, such a distinction may be difficult to make. We present a case where we were faced with difficulty labeling the origin of psychotic symptoms in a patient who was otherwise a heavy user of Cannabis. Management options considered in the presence of insoluble diagnostic problem have also been discussed.

A number of defendants with chronic psychotic disorders are opined incompetent to stand trial and are subsequently committed for competency restoration. To the best of our knowledge, the role of clozapine in restoring competency among defendants suffering from treatment-resistant schizophrenia has not been previously reported. This article reports a defendant with a diagnosis of treatment-resistant schizophrenia, who was treated with clozapine and restored to competency within a short duration. During a subsequent hospitalization, the same patient was treated with different antipsychotic medications and was found “incompetent to stand trial and unlikely to be restored.” Therefore, clozapine may play an important role in restoring competency in patients with chronic psychotic illness. The authors discuss the potential benefits and underutilization of clozapine therapy in competency restoration.

Gambling is defined as staking something on a contingency. Many traders are gambling without even knowing it. Health professionals need to consider the harmful effects of gambling considering that gambling can destroy families and has medical consequences. A 40-year-old bank manager diagnosed initially with mood disorder with two attempts of self-harm in the past 3 years was eventually diagnosed as a case of gambling addiction using both the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria and Problem Gambling Severity Index. The participant's gambling urges were not caused by any “trigger” incident, were independent of mood disorder, and were so severe to lead him to deliberate self-harm. Even after adequate trial of two mood stabilizers from different classes including lithium, the patient neither showed improvement in mood symptoms nor his gambling behavior; however, patient's gambling behavior and mood symptoms both showed marked improvement following start of naltrexone up to a dose of 100 mg/day and were maintained at 6-month follow-up with gradual decline in craving for gambling as monitored on Problem Gambling Severity Index. Gambling addiction appears to be a very serious problem and can cause significant problems in the lives of people it affects and their family members.

The themes of delusion have been a subject of interest due to the complex underpinning of several socio-cultural aspects. Although it is defined to be out of keeping with the socio-cultural background, the interplay often poses a diagnostic dilemma. Here, we report an unusual case of persistent delusional disorder involving surgically inserted “Gas” in the background of beliefs arising from relatives, lay press, and nontraditional medicine.

Shared paranoid disorders, a relatively rare psychiatric disorder in which paranoid delusions are transferred from one individual to one or more other susceptible person(s) in close association. Folie a deux is characterized by a complex dependent relationship between the involved individuals, yet a challenging diagnosis. In the paradigm of changing nosology, where the term shared/induced psychotic disorder is going obsolete, it is important to recognize such cases due to the potential for recovery in the submissive partner. Here, we present a case report and discussion of folie a deux involving inducer mother and induced daughter. In the clinical case presented, folie á deux was easily diagnosed, but its treatment proved to be a bigger challenge.

The work of early pioneers like Dorothea Dix was instrumental in the establishment of institutions dedicated especially for the care of the mentally ill. Originally from the United States, she became acquainted with the idea of humane treatment of the mentally ill during her visit to England. After her return to the United States, she conducted a statewide investigation of care for the insane poor in Massachusetts and began to extensively lobby for reforms and establishment of more state-funded institutions for the care of mentally ill. Her efforts led to setting up of several mental health institutions, which became the cornerstone of care of psychiatrically ill, and for training of mental health care providers. Though subsequently, the hegemony of the institutions was challenged, and the era of deinstitutionalization was ushered in, the work of Dorothea Dix is important as it vouched for humane care of patients with mental illnesses.