BHAGWAT ABSTRACTS

Loneliness and mental-health: Assessing the association between loneliness, mental-health and psychiatric-disorders Ankan Paul, Farhana Maulana1 Department of Psychiatry, Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair, Andaman and Nicobar Islands, 1Department of Psychiatry, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India Background: Loneliness which often leads to isolation has emerged as a major determinant of mental health outcomes. It has been linked to increased risk of psychiatric disorders, particularly depressive disorder and spectrum of anxiety disorders. Likewise, mental-health conditions are also known to impact perception of loneliness to varying degrees. Past research underscores the pervasive impact of loneliness across population groups, but their role among individuals with differing psychiatric histories remains underexplored. Also, the subtle differences in impact of emotional loneliness and social loneliness on mental-health have not been studied in depth. Aim: This study aimed to evaluate the association between loneliness and mental health among subjects with and without pre-existing psychiatric diagnoses. The study also aimed to delineate the impact of emotional loneliness and social loneliness on mental-health. Methods: A cross-sectional study of 60 participants aged 45-66 years was conducted using proforma designed to capture the socio-demographic details and psychiatric history. Parameters of loneliness, emotional and social components of loneliness, and mental-health issues were assessed via validated instruments. Statistical analysis consists of descriptive as well as inferential statistics, including linear regression as applicable. Significant Results: Mean age of participants in subset without psychiatric diagnosis was 55.13 +/- 6.02, while that for subset with previous psychiatric diagnosis was 55.46 +/- 6.01. Difference of scores between subsets on UCLA Loneliness Scale Version 3 were found to be statistically significant. Although, differences were found to be statistically significant for De Jong Gierveld Scale Total scores and emotional loneliness scores, but difference was non-significant with respect to social loneliness scores. Conclusion: Psychiatric history markedly influences severity of loneliness. Loneliness further impacts and often aggravates mental health. While social loneliness is often highlighted and addressed to some extent, the brunt of emotional loneliness may go unnoticed and unattended. Key words: Loneliness, mental health, psychiatry Sleep procrastination and its association with binge-watching behaviors 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 revolutionized media consumption, promoting binge- watching behaviors that significantly impact sleep patterns among adults, particularly MBBS students. This study examines the correlation between binge-watching on OTT platforms and bedtime/sleep procrastination among medical students. Objectives: To assess the correlation between binge-watching and bedtime procrastination among undergraduate medical students, compare severity across different demographic factors, and evaluate associated behavioral patterns. Methods: A cross-sectional observational study was conducted among 506 undergraduate medical students in Ahmedabad, Gujarat. Data were collected using validated questionnaires: Binge-Watching Questionnaire (BWQ), Bedtime Procrastination Scale (BPS), and socio-demographic assessments. Statistical analysis included Pearson correlation coefficients and ANOVA. Results: Among 506 students, 65.6% (n=332) reported binge-watching behavior. A significant positive correlation was found between binge-watching and bedtime procrastination (r = 0.366, p < 0.001). Binge-watchers had significantly higher BPS scores (28.18± 5.60) compared to non-binge-watchers (24.93± 6.97). First-year students and higher-income groups showed significantly higher binge-watching rates. Mobile devices were the most common platform for binge-watching (41.0%). Conclusion: Binge-watching on OTT platforms is significantly correlated with bedtime procrastination among medical students, potentially compromising sleep quality. Targeted interventions addressing media consumption habits are essential for promoting healthy sleep patterns in medical education. Diagnostic concordance and referral pattern among patients referred to psychiatry department in a tertiary care hospital Subathra Brammanathan, Sriramadesigan Radhakrishnan, Naveen Thiyagarajan Department of Psychiatry, Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, India Introduction: The framework of consultation-liaison psychiatry (CLP) is continuously evolving; however, gaps remain in understanding referral patterns and diagnostic concordance among referred patients. Aims and Objective: To study the pattern of referrals in different settings and the diagnostic concordance between non-psychiatrists and the CLP team. Methods: This observational study was conducted from February 2024 to February 2025. Patients referred to the CLP team from various settings including Inpatient (IP), Outpatient (OP) and emergency services. The referrals were evaluated and diagnosed as per ICD-10. Results: Of 272 referrals, 57.7% (n=218) were male; with mean age of 43 years. The referral rate for OP, emergency services and IP was found to be 0.06%, 0.78% and 1.1% respectively. Substance use (n=103; 37.2%) was the most common reason for referral followed by anxiety (n=32; 11.7%) and mood symptoms (n=30; 11%). The most common diagnosis made was Substance Use Disorder (SUD) in IP and emergency services and affective disorders in OP settings. SUD had the highest diagnostic concordance rate of 77%, while organic causes showed least concordance rate of 16%. Conclusion: Our study highlights underutilization of CLP services often stemming from stigma, lack of awareness and inadequate training about psychiatric illness among various medico-surgical specialists. Keywords: Liaison psychiatry; CLP; Referral pattern; Diagnostic concordance. Factors associated with relapse in patients receiving clozapine: An exploratory study Neha Sharma Department of Psychiatry, PGIMER, Chandigarh, India Aim: To evaluate the factors associated with relapse among schizophrenia spectrum disorder (SSD) patients receiving clozapine. Methodology: Forty-two patients with SSD (receiving clozapine for at least 6 months and currently symptomatic) and 120 patients with SSD (receiving clozapine for at least 6 months in remission) were assessed on validated scales for psychopathology including insight, functioning, severity of illness, medication adherence, side effects, stressful life events, expressed emotions and social suppor. Results: Compared to patients in remission, a higher proportion of patients in the relapse group were unemployed, had lower income, had a history of surreptitious use of antipsychotics, history of use of long-acting injectable antipsychotics, past history of receiving electroconvulsive therapy (lifetime, last 5 years, and 2 years), experiencing higher number of side effects with current medications, history of higher number of relapses in lifetime due to poor medication adherence, higher number of relapses in lifetime on clozapine due to poor adherence, need for caregivers to ensure the intake of the medications, concomitant use of mood stabilizers and benzodiazepines, shorter duration of clozapine use, higher number of hospitalizations, history of higher number of relapses (in the lifetime, last 5 years, and 2 years), presence of comorbid depression, poor social support, higher expressed emotions and higher number of life-events preceding 6 months of relapse. Conclusion: Relapse among patients receiving clozapine is associated with multiple factors related to previous treatment history, disease related factors, and psychosocial factors. Overwhelming stress, expressed emotions and poor adherence contribute to relapse of symptoms in patients receiving clozapine. Key words: Clozapine, relapse, schizophrenia Validation of Tamil translation of the survey of well-being of young children (SWYC) for early screening of neurodevelopmental disorders in Indian children Rini Joseph, Allen Johnson National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India Background: Neurodevelopmental disorders (NDDs) affect a significant proportion of young children in India, making early identification crucial for timely intervention. Aim: To translate and validate Tamil version of Survey of Well-being of Young Children (SWYC), a comprehensive, caregiver-completed screening tool for developmental delay and emotional-behavioural problems in children aged 12–60 months. Methods: This cross-sectional study was conducted in a public sector hospital in southern India. The SWYC was translated into Tamil using World Health Organization guidelines, involving forward and back translation, cognitive interviewing, and expert review. Primary caregivers of 100 children aged 12–60 months were recruited from the Paediatric OPD. Children were screened using SWYC and independently evaluated by two experts using the DC 0-5TM diagnostic criteria, whose consensus diagnosis served as gold standard for identifying NDDs. The validity of SWYC components was tested against this standard. Results: The clinical consensus diagnosis identified 23% of children with NDD. The mean scores of various SWYC components differed significantly between NDD positive and NDD negative children. Against the expert clinical consensus, SWYC components showed low sensitivity but high specificity in detecting NDDs. Conclusion: The SWYC is a practical, cost-free screening tool with high specificity. A positive screen should prompt referral to early intervention services. Its brevity (takes ~ 10 minutes) and coverage of multiple domains makes it a good fit for routine paediatric OPD, especially in resource-limited settings. A study on the prevalence of attention deficit hyperactivity disorder (ADHD) in medical students and its association with sleep quality Sagar Rakh Department of Psychiatry, K J Somaiya Medical College & Research Centre, Mumbai, Maharashtra, India Introduction: ADHD is increasingly recognised as a lifelong condition, often persisting into adulthood and impacting daily functioning. Among medical students, ADHD can pose significant challenges, affecting academic performance, time management, and overall well-being. At the same time, sleep disturbances are common in this population and may further worsen ADHD symptoms. Despite these concerns, there is limited research on the prevalence of ADHD and its relationship with sleep quality in medical students. Aims and Objectives: The study aims to determine the prevalence of ADHD among medical students, assess their overall sleep quality, and explore the association between ADHD and sleep disturbances in this population. Methodology: A cross-sectional study was conducted at a medical colleges in Mumbai. Medical students who met the inclusion criteria participated in the study. ADHD symptoms were assessed using the Adult ADHD Self-Report Scale (ASRS-1.1), and sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). The collected data were analysed using statistical tests, including the Chi-square test and Odds ratio. Results: Our study revealed that one in four medical students were diagnosed with ADHD, with the inattentive presentation being the most prevalent, followed by the combined and hyperactive/impulsive presentations. Sleep problems were highly prevalent among the study population. Importantly, a significant association was observed between ADHD and poor sleep. Conclusion: These findings emphasise the need for regular screening of ADHD and sleep quality in medical students, along with timely interventions to address both conditions. Key words: Adult attention deficit hyperactivity disorder, medical students, sleep quality Assessment of the prevalence and pattern of neuro-psychiatric conditions among the patients undergoing polysomnography in a tertiary care hospital Meghal Gulati, Jigyansa Ipsita Pattnaik Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India Background: The field of sleep medicine has progressed significantly since the early 20th century, marked by key discoveries in electrical brain activity and EEG development. PSG has emerged as a critical diagnostic tool in sleep medicine, providing comprehensive insights into the electrophysiological parameters of sleep disorders and their correlations with various medical and psychiatric conditions. This article aims to assess the prevalence and pattern of neuro-psychiatric conditions among the patients undergoing polysomnography in a tertiary care centre. Methodology: The study, a cross-sectional non-interventional study conducted in a tertiary care center in India, involving consenting adults in age group of 18-65 years over a period of 2 years after approval from institutional ethics review board. Results: Our study was suggestive of prevalence of psychiatric disorders among patients attending the polysomnography clinic to be 32.40%, 10.2% had Major Depressive Disorder at that time and 5.6% had in the past, 5.6% had Generalized Anxiety disorder, 2.8% had Panic disorder, 1.9% had psychotic disorder, 0.9% had Manic episode and OCD each. Distinct sleep parameter profiles were identified across psychiatric disorders with and without comorbid obstructive sleep apnea (OSA). Major Depressive Disorder showed significant alterations in supine sleep, AHI, RERA, and RDI, while past and persistent depression were linked to reductions in REM and non-supine sleep. Panic Disorder was characterized by increased REM latency and supine obstructive apneas, whereas Generalized Anxiety Disorder showed non-significant trends toward longer sleep duration and efficiency. These findings highlight disorder-specific variations in sleep architecture and the need for further exploration of their clinical implications. Hepatic safety of chronic paracetamol–tramadol misuse: Retrospective evidence from an Indian tertiary care cohort New Fight Seth, Asmita Vashisht, Omar Afroz1, Apinderjit Kaur National Drug Dependence Treatment Centre, 1Department of Psychiatry, AIIMS, New Delhi, India Background: Paracetamol is a leading cause of drug-induced liver injury in Western countries, particularly at supratherapeutic doses or when combined with opioids such as tramadol. Evidence on its long-term hepatic effects in Indian populations is scarce. Methods: This retrospective study assessed the prevalence of hepatic dysfunction in opioid-dependent male patients (18–60 years) admitted to a tertiary care drug treatment facility in North India between August 2024 and August 2025. Records of patients with alcohol misuse, viral hepatitis, injection drug use, or pre-existing liver disease were excluded. Seventy patients with chronic daily supratherapeutic use of fixed-dose paracetamol–tramadol (Spasmoproxyvon Plus) were included. Data on sociodemographics, substance use, liver function tests, aspartate aminotransferase-to-platelet ratio index (APRI), and drug intake were analyzed. Results: The median duration of use was six years, with a median daily intake of 5.7 g paracetamol and 0.9 g tramadol. Only one participant (1.4%) showed hepatic injury (ALT/AST >3× upper limit of normal). None had APRI scores >1.5, indicating absence of significant hepatic fibrosis. Elevated gamma-glutamyl transferase (GGT) was observed in 37% of patients, possibly linked to tobacco or tramadol use. No correlation was found between APRI scores and dosage. Conclusion: Significant hepatotoxicity was rare despite long-term supratherapeutic intake. Findings highlight potential protective factors, including lifestyle and ethnic differences in paracetamol metabolism. Larger prospective studies are warranted. Predictors of menstrual irregularities among patients with severe mental illness and its impact on treatment adherence Pooja Shakya, Simran, Seshan, Poulami Basu Institute of Human Behavior and Allied Sciences (IHBAS), New Delhi, India Background: Menstrual irregularities (MIs) are frequently observed in women with severe mental illness (SMI), and can adversely affect their quality of life. This study aimed to assess the menstrual irregularities among psychiatric inpatients and its socio-clinical correlates. Methods: 253 female inpatients aged 18–50 years with severe mental illness were assessed cross-sectionally capturing their socio-clinical characteristics. Menstrual distress was measured with the Menstrual Distress Questionnaire (MEDI-Q), and treatment adherence was assessed by the Brief Adherence Rating Scale (BARS). Results: Out of 253 psychiatric patient menstrual irregularities (MI) were present in 39.5% (n=100) of patients. Psychotic disorders were the most common diagnosis associated with MIs, and typical antipsychotic use was linked to a higher MI prevalence than atypical antipsychotics. Logistic regression identified longer illness duration (adjusted odds ratio [AOR] = 1.12, 95% CI: 1.01–1.25; p=0.034), typical antipsychotic use (AOR = 3.85, 95% CI: 1.60–9.27; p=0.003), and poor treatment adherence (AOR = 4.14, 95% CI: 1.57–10.94; p=0.004) as independent predictors of menstrual irregularities. Conclusion: Menstrual irregularities are common among women with severe mental illness, leading to poor treatment adherence and adverse illness outcomes. This highlights a need for integrated, gender-sensitive psychiatric care that includes routine menstrual health assessment. Key words: Antipsychotics, menstrual irregularities, psychiatric patients, severe mental illness, treatment adherence Subjective memory complaints: Early warning signals of cognitive decline and mood disturbances Raghav Singh, K. Rashmi, Amritha Ajay, Vidya Nittur, B. R. Abhijna Department of Psychiatry, KVG Medical College and Hospital, Dakshina Kannada, Karnataka, India Background: Subjective memory complaints (SMC) often precede measurable cognitive deficits and may serve as early markers of cognitive decline. Data on SMC in Indian adults aged ≥50 years are limited. Methods: This cross-sectional study at a tertiary care centre in India included 92 adults aged ≥50 years with SMC. Participants underwent assessment with the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Activities of Daily Living (ADL) scale. Results: All participants reported SMC, with moderate complaints most frequent (59.8%). MMSE revealed mild cognitive impairment in 54.3% and moderate impairment in 39.1%, whereas MoCA identified moderate impairment in 77.2%. Mild depression and anxiety were reported in 71.7% and 55.4% of participants, respectively. Functional independence was preserved in 84.8%. SMC severity correlated inversely with MMSE (r = –0.48, p < 0.001) and MoCA scores (r = –0.62, p < 0.001). Conclusion: SMC is highly prevalent among Indian adults aged ≥50 years and frequently coexists with objective cognitive impairment and mood symptoms, while functional independence is largely maintained. These findings suggest that routine evaluation of subjective memory concerns, combined with cognitive and psychological assessment, may enable early detection and preventive strategies to delay progression to dementia. Further longitudinal studies are warranted to clarify the prognostic significance of SMC in this population. Key words: Anxiety, cognitive impairment, depression, mini-mental state examination, MoCA, subjective cognitive decline, subjective memory complaints