Indian Journal of Psychiatry最新文献

The competitive entrance examination system in India has led to a concerning mental health crisis among students, especially in coaching centers such as Kota, Rajasthan, where student suicides persist despite greater awareness and policy intervention. This viewpoint paper examines the neurodevelopmental and sociocultural stressors affecting adolescent students in coaching environments, critiques existing policy gaps, and proposes a comprehensive three-tiered prevention framework for integrating mental health support within coaching ecosystems. The framework encompasses universal support mechanisms, targeted early identification protocols, and crisis response systems to reduce psychological distress and promote resilience in high-stakes academic settings. Implementation models distinguish between minimal and ideal components to accommodate diverse resource settings, while maintaining evidence-based prevention principles. The framework addresses stakeholder concerns through culturally adapted interventions that reconceptualize mental health support as integral to educational environments, rather than an ancillary service. For Indian psychiatry, this crisis necessitates expanded professional roles that encompass prevention, consultation, and the development of educational systems beyond traditional clinical treatment. Sustainable solutions require collaborative partnerships between coaching institutions, mental health professionals, families, and policymakers to create environments where academic excellence and psychological well-being are mutually reinforcing rather than competing priorities.

Background: Delirious mania (DM) is a rare, life-threatening neuropsychiatric syndrome marked by the simultaneous presence of manic excitement, catatonia, and fluctuating consciousness. Although described extensively in Western literature, Indian reports remain limited.

Cases: Four patients admitted to a government mental hospital in Central India were retrospectively evaluated for clinical features, investigations, comorbidities, treatment, and outcomes. All had a prior diagnosis of bipolar disorder and presented with acute agitation, grandiosity, disorientation, and catatonic features; two had past DM episodes. Comorbid hypertension and metabolic disturbances were noted in two cases. All showed clinical improvement with lorazepam, sodium valproate, and atypical antipsychotics, while one required electroconvulsive therapy for full resolution. Symptom stabilization occurred within 7-14 days of targeted treatment. Ethical approval and informed consent procedures were duly followed.

Conclusion: DM should be considered in bipolar patients presenting with catatonia and delirium. Early recognition and multimodal treatment, including electroconvulsive therapy (ECT) when needed, ensure favorable outcomes.

Background: Late-onset bipolar disorder (LOB) presents unique diagnostic and management challenges as various symptom overlaps with neurocognitive disorders, medical comorbidities, and age-related physiological changes.

Cases: We report four elderly patients presenting with first-episode mania, highlighting clinical trajectories, comorbidities, and treatment responses. Three patients had metabolic comorbidities, while two had family history of psychiatric illness. Neuroimaging revealed small vessel ischemic changes in two cases, suggesting a vascular contribution. All patients required inpatient care and responded well to mood stabilizers and antipsychotics.

Conclusion: Further research is warranted to optimize management strategies for this understudied subset of bipolar disorder.

Background: Assessment of medicolegal cases referred from the Court of Law/Prison has both mental health and legal implications. Most of the medicolegal cases, who are committing the crime are associated with comorbid psychiatric conditions that need assessments both for treatment and legal point of view considering the punishment.

Aim: The study aims to find an association between sociodemographic variables and criminal behaviors and focuses on other sociocultural factors responsible for crime.

Methods: The study involved a record based analytical cross sectional study, which included detailed medical histories, sociodemographic profiles, information about referrals of criminal behaviors and treatment records of under trail prisoners admitted from 2014 to 2024.

Results: Statistically significant associations were found between family type and criminal behaviors (P < 0.05) and family history of mental illness and criminal behaviors (P < 0.05). The mental health morbidity was directly proportional to the duration of the stay in prison as per the findings (P < 0.05).

Conclusion: The study findings concluded that sociodemographic determinants like male gender, unemployment, rural habitat, and persons living in the nuclear family were more involved in criminal behaviors, and prisoners who were spending more time inside the prison, due to negative psychosocial environment, had increased incidence of psychiatric illness.

Background: Psychotic symptoms involving sexual content remain underreported in schizophrenia, particularly in Indian settings.

Cases: Six patients with schizophrenia presenting with sexually themed delusions or hallucinations as core psychopathology were reviewed. Data were extracted through chart review with informed consent and de-identification. Diagnostic formulation was based on ICD-11 criteria, and insight was assessed on a 5-point clinical scale. The mean age was 32 years; five patients were female. Presentations included somatic passivity, delusional perception, and delusion of control. Three patients met criteria for treatment-resistant schizophrenia and responded to clozapine.

Conclusion: Sexually themed psychotic experiences may occur as prominent features of schizophrenia, particularly in chronic or treatment-resistant cases. Awareness of such presentations can facilitate culturally sensitive diagnosis and management.

Background: Cyberchondria refers to an increase in anxiety and distress because of excessive and repeated online health searches. The Cyberchondria Severity Scale-12 (CSS-12) is the most widely used validated measure to assess cyberchondria. It has consistently emerged as a reliable and valid brief measure to assess cyberchondria.

Aim: The current study validated the CSS-12 for the Indian adult population.

Methods: The data was collected online using a cross-sectional design from 326 participants (M age = 24, IQR (21, 26), 48.5% females). The datasheet consisted of a sociodemographic questionnaire, CSS-12, Statistical analyses comprised confirmatory factor analyses (CFA), internal consistency, test-retest reliability, cut off categories, regression, and differences in sociodemographic variables.

Results: The content validity index (CVI) for relevancy, accuracy and clarity of the scale was 0.99, 0.97, and 0.92, respectively. CFA showed good fit indexes [comparative fit index (CFI) = 0.929; Tukey-Lewis's index (TLI) = 0.903; root mean square error of approximation (RMSEA) = 0.75]. Internal consistency and test-retest reliability were 0.74, 0.81, respectively. 5.8% fall in the moderate level of cyberchondria and 2.1% of participants were found to have high level of cyberchondria.

Conclusion: It can be used for detection, management, and treatment monitoring purposes.

Increasing internet use among children and adolescents has raised significant mental health concerns, including anxiety, depression, cyberbullying, gaming addiction, and social withdrawal. Recent research highlights innovative international measures to combat internet addiction among children and adolescents, such as limiting or banning usage. However, the lack of clarity in implementing such bans underscores the need for empirically tested and actionable strategies. This paper underscores the importance of national-level guidelines, policies, collaborative research efforts, as well as pragmatic guidelines from regulatory bodies to address the escalating concerns of technology addiction. This viewpoint article provides a summary of current policies and mental health-focused recommendations, which underscores the urgent need for a holistic policy framework to safeguard children and adolescents' mental well-being and promote their responsible engagement with digital technology in an increasingly interconnected world.

Non-invasive brain stimulation (NIBS) has been an increasingly used therapeutic modality for neuropsychiatric disorders in recent decades. This review attempts to discuss the extent of use (availability of facility, indications of use, amount of research) of various newer NIBS techniques in the management of psychiatric disorders in the South Asian countries till date (i.e., 2025). In South Asia, particularly in India, there has been a notable rise in the use of NIBS treatment methods. Among these, the most prominent techniques are Repetitive Transcranial Magnetic Stimulation (rTMS) and Transcranial Direct Current Stimulation (tDCS), both of which demonstrate encouraging results with minimal side effects. Over the past decades, research into non-invasive neuromodulation has expanded significantly, although it remains predominantly centered in India. This growing body of evidence underscores the potential of these techniques to transform the treatment landscape for psychiatric conditions, offering a hope for patients seeking alternatives to conventional therapies. As interest in neuromodulation continues to grow, the future seems promising for the integration of these advanced modalities into clinical practice.