Recently, a dangerous new designer drug mephedrone has fast gained popularity among the youth and teens of India. Its abuse has soared to mount to an epidemic. It has psychoactive properties and is believed to bring about effects similar to the use of cocaine, amphetamine, and 3,4-methylenedioxy-N-methylamphetamine. The aim of this review is to discuss how mephedrone acts, health risks with its use and its emergence in India. The past and the emerging PubMed and Internet literature on mephedrone, and synthetic cathinones are reviewed. Recent studies suggest that use of synthetic cathinones lead to not just serious psychiatric but serious neurological, cardiovascular, and sexual health sequelae as well. Use of these designer drugs may lead to multi-organ failure and death. It has become increasingly evident that mephedrone is highly dangerous to public health. This warrants educating and training healthcare providers to provide optimum management.

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Lithium is a commonly used mood stabilizer. However, because lithium has a low therapeutic index, lithium-induced drug toxicity is frequently seen in clinical practice. While most side effects of lithium use reverse after the drug is discontinued, in rare cases patients develop a persistent neurological side effect known as a syndrome of irreversible lithium-effectuated neurotoxicity (SILENT). We report a case where the patient developed SILENT even when given a therapeutic dose of lithium. Our case also supports the biological mechanism of SILENT, which involves demyelination at multiple sites in the brain.

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Introduction: Job satisfaction and organizational stress among employees are two important key components of any successful organization. It is important to maintain a balance between the level of job satisfaction and perceived stress among nurses for rendering quality care in the health sector. Materials and Methods: A correlational study design was adopted for the study. A simple random sampling technique was used to recruit 100 staff nurses working at a tertiary care hospital. Job satisfaction scale (JSS) and the organizational role stress (ORS) scale were used to collect data related to job satisfaction and ORS among nurses. Results: Study results showed that majority (92%) of staff nurses were ambivalent regarding their job satisfaction. There was a significant negative relationship between ORS and job satisfaction (r = −0.289, P < 0. 01) among staff nurses. Discussion: The study revealed that many factors influenced job satisfaction and ORS among nurses. Nurse managers and administrators must be alert to suggest the suitable interventions timely to ensure the staff nurses satisfied and get a hassle-free working atmosphere.

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Background: There is a scarcity of research on the temporal sequence of improvement with antidepressants and the differential effect of different antidepressants. Aims: To study the temporal sequence of improvement and differential pattern of outcome with antidepressants from different classes. Methods: 132 males and females from 18 to 65 years suffering from the first depressive episode were followed up at baseline, 3 ^rd day, 7 ^th day, 10 ^th day, 14 ^th day, 21 ^st day, 1 month, and 3 months using the 17 item Hamilton Rating Scale for Depression. Patients were randomized into three groups namely (1) sertraline (2) des-venlafaxine and (3) imipramine. Appropriate statistical analyses were applied. Results: The pattern of improvement was similar across the groups. The earliest improvement was seen in early insomnia (at day 3) followed by suicidal ideas and psychological anxiety (by day 7). Middle insomnia, late insomnia, and agitation improved by the 14 ^th day. Depressed mood improved significantly at day 14 ^th in the sertraline and imipramine groups and day 21 ^st in the des-venlafaxine group. Work and activities and retardation improved significantly in the sertraline and imipramine groups at 1 month. The last symptoms to improve were general somatic symptoms, genital symptoms, and guilt feeling. Conclusions: It is important to know the temporal sequence of symptomatic improvement with antidepressants as it will guide us to make important management decisions. It also helps to improve compliance as patients can be appropriately guided regarding expected course of treatment.

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In the last century, numerous soldiers had been diagnosed with various post combat disorders. The terminology that has been utilized to describe such patients include combat fatigue, combat stress reaction, soldier's heart, effort syndrome, non-ulcer dyspepsia, effects of agent orange and gulf war syndrome. The initial description of such post combat disorder was probably 'shell shock' which came into vogue during the World War I. The soldiers, undergoing unyielding artillery bombardment, in the trenches suffered persistent symptoms of headache, behavioural changes and memory impairment, and was designated at the time as 'shell shock'. Myers and Mott, independently studied numerous soldiers to elucidate the features and aetiology of the entity. An attempt was made to restrict the usage of the term, but the psychological distress of the soldiers persisted to be addressed in some manner or the other, culminating in the genesis of Post Traumatic Stress Disorder.

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Context: As psychiatric illness requires long-term treatment, some patients are lost to follow-up. Aims: The present study aimed to find the follow-up pattern of psychiatric patients attending psychiatry outpatient department (OPD) and to determine the correlation of follow-up with socio-demographic profile and diagnosis, if any. Settings and Design: This study was a retrospective data analysis study carried out at the OPD of Psychiatry, Christian Medical College and Hospital, Ludhiana. Subjects and Methods: New cases attending the OPD from April 2010 to March 2011 were included in this study. The data were scrutinized 1 year after the initial assessment. Socio-demographic data, diagnosis and follow-up information were obtained from the files. The collected data were statistically analyzed. Statistical Analysis Used: Chi-square and P value. Results: 53.1% of the patients dropped out after first visit, 29.4% patients had 1-3 follow-up, 14.9% had 4-10 follow-ups and only 2.6% had more than 10 follow-ups. Correlation between follow-up and various socio-demographic variables such as age, gender, place of living or distance from hospital, occupation, religion and marital status was not statistically significant. It was, however, seen that cognitive disorders, conversion disorder, mental retardation, and patients in which diagnosis was deferred, had more dropout rate after first visit. Conclusions: In our study 53.1% of the patients did not attend follow-up at all and only 2.6% had more than 10 follow ups. Correlation between follow-up and various socio-demographic variables was not statistically significant. Patients in which diagnosis was deferred had more drop out rate than patients who had a diagnosis and the difference was statistically significant.

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Introduction: Traumatic brain injury (TBI) is a leading cause of death and disability all over the world. It is associated with diversities of outcomes including cognitive deficits. The worse cognitive outcome is often associated with more severe degree of TBI as measured by initial Glasgow Coma Scale (GCS) score. Materials and Methods: Present study compared the cognitive function of TBI patients having initial GCS score 9-10 with those having the initial GCS score 11-12. The assessment on Postgraduate Institute battery of brain dysfunction was conducted when the patients came for their follow-up visit at a tertiary health care facility between 6 months and 12 months of sustaining TBI. Results: There was moderate degree of cognitive dysfunction in the group with initial GCS score of 9-10 and no dysfunction in the group with initial GCS score of 11-12. Conclusion: The initial GCS score of 10 may be critical to predict cognitive deficits among TBI patients during 6-12 months of recovery period.

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Context: Number of scientific personnel traveling to Antarctica for short summer stay far outnumbers winter personnel. Hence, psychological issues confronting such personnel need to be analyzed in detail. This study aims to study changes in psychological health, cognitive functioning, changes in motivation levels, and tobacco and alcohol consumption during a summer in Antarctica. Aims: To study changes in psychological health, cognitive functioning, changes in motivation levels and tobacco and alcohol consumption during a summer in Antarctica. Setting and Design: This cohort study was conducted on 33 summer team members of 27 ^th Indian Scientific Expedition to Antarctica. Subjects and Methods: Seven instruments were administered to assess general health, alcohol and tobacco dependence, memory and cognitive functioning of the team members. Statistical Analysis Used: The data were analyzed for statistical significance using nonparametric Wilcoxon Signed Rank Sum Test. Results: Scores on social dysfunction, depression, and somatic symptoms increased. Tobacco consumption also increased concomitantly. However, memory and cognitive function were not impaired. Alcohol consumption did not change. None of the subjects needed medication or evacuation for psychological difficulties. Conclusion: Psychological issues might manifest themselves even during a short stay in Antarctica during the summer season.

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A case of caffeine dependence syndrome with preference for a specific brand of carbonated water (popularly known as soft drinks or colas) is discussed to highlight the clinical and policy implications.

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