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Aims: Recent research has focused on the inflammatory cascade as a key culprit in the aetiology of Bipolar disorder. We hypothesized that celecoxib, via its anti-inflammatory properties, may have a therapeutic role in mood disorder. The present study was a 4 weeks, open label case-control trial of celecoxib in patients of Bipolar mania as an adjunctive therapy to mood stabilizer and antipsychotic and to see its effect on IL-6 levels to objectively validate the improvement caused by celecoxib using this inflammatory marker. Methods: This was a hospital-based, prospective, case-control study using purposive sampling. The study consisted of 50 participants of over 18 years of age, of which 25 received celecoxib (200 mg/day) adjunctive therapy to sodium valproate and a second generation antipsychotic while the other 25 received treatment as usual for 4 weeks. 25 healthy controls were also taken to measure and compare baseline serum Interleukin 6 levels. The Young Mania Rating Scale (YMRS), Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression – Severity scale (CGI-S) were used to assess severity of symptoms at baseline and at 4 weeks. The serum Interleukin 6 level was measured at baseline and at 4 weeks using an ELISA kit. Results: The patients in each of the groups were comparable with respect to the socio-demographic, clinical characteristics and laboratory parameters at baseline. Interleukin 6 levels in the patient groups were significantly elevated when compared with healthy controls. Repeated measures ANOVA showed significant effect on treatment × time interaction on YMRS [F (1, 48) = 104.69, p<0.001] BPRS [F (1, 48) = 9.298, p = 0.004] and CGI-S [F(1, 48) = 65.774, p<0.0001] scores. YMRS, BPRS and CGI-S scores significantly decreased at 4 weeks in Bipolar patients receiving celecoxib in comparison to Bipolar patients receiving treatment as usual. There was a significant decrease in the serum Interleukin 6 (p<0.001) while on treatment with celecoxib adjunctive when compared with treatment as usual. The baseline Interleukin 6 levels correlated significantly with the improvement in symptoms (p<0.009) and the baseline score on YMRS scale was a predictor of the improvement. Conclusion: This study found that celecoxib used as an adjunctive therapy with sodium valproate and antipsychotic in the treatment of Bipolar mania shows improvement in the manic and psychotic symptoms. It also significantly lowers Interleukin 6 levels of participants which were raised when compared with the healthy controls.

The use of feedback to address gaps and reinforce skills is a key component of successful competency-based mental health and psychosocial support intervention training approaches. Competency-based feedback during training and supervision for personnel delivering psychological interventions is vital for safe and effective care. For non-specialists trained in low-resource settings, there is a lack of standardised feedback systems. This study explores perspectives on competency-based feedback, using structured role-plays that are featured on the Ensuring Quality in Psychosocial and Mental Health Care (EQUIP) platform developed by the World Health Organization and United Nations Children's Fund. Qualitative data were collected from supervisors, trainers and trainees from multiple EQUIP training sites (Ethiopia, Kenya, Lebanon, Peru and Uganda), from 18 key informant interviews and five focus group discussions ( = 41 participants). Qualitative analysis was conducted in Dedoose, using a codebook with deductively and inductively developed themes. Four main themes demonstrated how a competency-based structure enhanced the feedback process: (a) competency-based feedback was personalised and goal-specific, (b) competency-based feedback supported a feedback loop, (c) competency-based feedback supported a comfortable and objective feedback environment, and (d) competency-based feedback created greater opportunities for flexibility in training and supervision. A better understanding of the role of feedback supports the implementation of competency-based training that is systematic and effective for trainers and supervisors, which ultimately benefits the learning process for trainees.

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive and relatively painless tool that has been used to study various cognitive functions as well as to understand the brain-behavior relationship in normal individuals as well as in those with various neuropsychiatric disorders. It has also been used as a therapeutic tool in various neuropsychiatric disorders because of its ability to specifically modulate distinct brain areas. Studies have shown that repeated stimulation at low frequency produces long-lasting inhibition, which is called as long-term depression, whereas repeated high-frequency stimulation can produce excitation through long-term potentiation. This paper reviews the current status of rTMS as an investigative and therapeutic modality in various neuropsychiatric disorders. It has been used to study the cortical and subcortical functions, neural plasticity and brain mapping in normal individuals and in various neuropsychiatric disorders. rTMS has been most promising in the treatment of depression, with an overall milder adverse effect profile compared with electroconvulsive therapy. In other neuropsychiatric disorders such as schizophrenia, mania, epilepsy and substance abuse, it has been found to be useful, although further studies are required to establish therapeutic efficacy. It appears to be ineffective in the treatment of obsessive compulsive disorder. There is a paucity of studies of efficacy and safety of rTMS in pediatric and geriatric population. Although it appears safe, further research is required to optimize its efficacy and reduce the side-effects. Magnetic seizure therapy, which involves producing seizures akin to electroconvulsive therapy, appears to be of comparable efficacy in the treatment of depression with less cognitive adverse effects.

Introduction1 The Corona Virus Disease 2019 (COVID-19) has ignited many debates and has undoubtedly shaken up the core foundations of the health-care system worldwide. There has been plenty of evidence that pandemic and the effects of lockdown have Studies have resulted in elevated levels of psychological symptoms such as depression, anxiety, phobia, trauma, etc. Concerning the COVID-19 outbreak (since late January 2020 in India), the first case that was reported in India is stated to be due to fear of being infected with COVID-19. Similarly, COVID-19 suicide occurrences were reported as of fear of infection, economic crisis and social boycott in Bangladesh and Pakistan, from the neighbouring countries of India. Though the report of the National Crime Record Bureau (NCRB) was released as last as October'21 this year, many of the incidents were reported by press and over social media platforms. The NCRB Statistics - 20202 A total of 1,53,052 suicides were reported in the country during 2020 showing an increase of 10.0% in comparison to 2019 & the rate of suicides has increased by 8.7% during 2020 over 2019. Majority of suicides were reported in Maharashtra (13.0%) followed by Tamil Nadu (11.0%), Madhya Pradesh (9.5%), West Bengal (8.6%) & Karnataka (8.0%). These 5 States together accounted for 50.1% of the total suicides reported in the country. Family Problems (33.6%) & Illness (18.0%)' were the major causes of suicides. Drug Abuse/Addiction (6.0%), Marriage Related Issues(5.0%), Love Affairs (4.4%), Bankruptcy or Indebtedness (3.4%), Unemployment (2.3%), Failure in Examination (1.4%) & Poverty (1.2%) were other causes. Daily wage earners accounted for the maximum percentage (24.6%). Hanging' (57.8%), consuming 'Poison' (25.0%), 'Drowning' (5.2%) and 'Fire/Self Immolation' (3.0%) were the prominent means/mode. Beyond the NCRB Statistics3 The NCRB report has some significant limitations. NCRB underestimates suicide rates due to under- reporting of cases & this data is usually made available after a significant delay of between 12 and 24 months. Furthermore, NCRB releases summary annual data rather than weekly or monthly data to analyse trends (Important during COVID19). NCRB does not keep any record of attempted suicides as well. Analysis of media reports reveals that the rates of suicide and attempted suicide between 24 March to 3 May 2020 compared to the same dates in 2019 showed a 67.7% increase in reported suicides and attempted suicides during the lockdown. More suicides & attempted suicides were by older employed men. Suicides increased in 2020 in states which traditionally have low suicide rates such as Bihar, Uttar Pradesh, Rajasthan, Haryana, and Chandigarh (also economically less developed & inadequate health infrastructure). There were 39 alcohol-related suicides & 7 attempted suicides as compared to no such suicide/ attempted suicide cases in 2019. Conclusion3 The possibility that the pandemic may have increased the risk of suicide as reflected from the media reports has been attested by the recently released NCRB data. However, both the reports are an underestimate of the true figures. The pandemic however has now provided an opportunity for cross- sectoral collaboration for suicide prevention rather than restricting suicide prevention to the health sector Symposium Proposal: Digital Phenotyping in Mental Health This symposium explores the emerging field of digital phenotyping in mental health. Despite developments, psychiatry heavily relies on patients' interviews and self-reporting to match the diagnostic criteria of the ICD or DSM and is still handicapped by the lack of objective measurements for diagnosis and management. Smartphones and wearables, which have emerged as new tools for health investigation, generate many digital fingerprints that provide insights into human behavior. They collect data in naturalistic settings in-situ, leveraging the lived experiences of patients and no longer confined to clinics or research laboratories. However, such technology with revolutionary potential is also associated with challenges and controversies. Various legal, ethical, and security issues concern digital phenotyping in mental health. The first presentation by Vijay Gogoi of LGBRIMH sets the scene for what follows1. He discusses the advent and concept of using digital devices and the Internet of Things (IoT) for personal sensing in the context of mental health. Terminologies like computational behavioral analysis, personal sensing, continuous measurement are being applied in similar research approaches. Hence, some researchers also view digital phenotyping as a variant of deep phenotyping, closely aligned with the goals of precision medicine and a new tool for the National Institute of Mental Health's Research Domain Criteria. Dhrubajyoti Chetia of LGBRIMH then discusses the various research trends in mental health using digital devices2. The features studied as behavioral markers for social context, stress, sleep, mood, and clinical disorders like depression, schizophrenia, and bipolar disorder will be discussed. Changes in location and activity patterns, keyboard interaction dynamics, voice modulation, social communication logs are used to predict depressive and manic states. Proactive screening in online environments and automatic natural language processing of social media posts have been used successfully to identify individuals with evidence of psychological distress. Signals from smartphones and clinical measurements may provide a safety net for patients at risk of self-harm or suicide. The challenges and limitations of using digital technology are highlighted by Sajjadur Rehman of Lady Hardinge Medical College3. Results are not comparable across studies because of varying data collection techniques and research designs. As most research is currently being carried out in small samples as proof of concept studies, replicating the same in a large population is a challenge. Variability from geographical location, characteristics of people, data types, environments, etc., is a barrier. With rapid technological advancements, and people changing their usage, machine learning algorithms are bound to become inaccurate. Finally, as health care professionals, the ethical and security concerns were discussed by Kunal Deb of LGBRIMH4. Accountability for safety and efficacy, usually assessed by government agencies, is still not well developed for digital health technologies. Strict data privacy and protection regulations also need to be in place. The use of various data streams may assist the third party in re-identifying individuals without their knowledge, with the potential impacts of mental health diagnosis and predictions on employment, insurance, litigation, and other contexts. 1.Vijay Gogoi, Associate Professor, Psychiatry, LGBRIMH, Tezpur, Assam 2.Dhrubajyoti Chetia, Associate Professor, LGBRIMH, Tezpur Assam. 3.Sajjadur Rehman, Assistant Professor, Psychiatry, Lady Hardinge Medical College, Delhi 4.Kunal Deb, Assistant Professor, Psychiatry, LGBRIMH, Tezpur, Assam.

Psychogenic non-epileptic seizures (PNES), also known as functional seizures, clinically mimic seizure-like activity without the presence of brain wave abnormalities on electroencephalogram (EEG). PNES, among other functional neurological disorders, demonstrates an increased prevalence among transgender and non-binary individuals, particularly those with ongoing gender dysphoria. It is established that PNES episodes can be triggered by states of severe distress and that mirror-gazing may cause distress in individuals with gender dysphoria. Herein, we review the available research on the pathophysiology of PNES. We also describe a 16-year-old non-binary patient with gender dysphoria, initially admitted following a suicide attempt, who experienced multiple PNES episodes upon entering their bathroom. Once bathroom access was restricted and the patient was supervised with a bedside commode, they experienced no further episodes on the unit. With no other potential triggers identified, we hypothesized that the patient's symptoms were evoked by their reflection in the bathroom mirror, causing such great distress that it resulted in dissociation and PNES. This is a case of mirror-gazing potentially inducing PNES in a non-binary patient.

The internet has become a part of everyday life. This growing technology has a vast impact on the life of many people. In the field of mental health, the electronic services are rapidly gaining acceptance. The psychometric tests are an important tool in the field of psychology. The use of internet as one of the modes of delivery of psychological tests has been discussed.

Schizophrenia is a chronic, debilitating illness requiring long-term treatment with antipsychotic medications. These antipsychotic medications are associated with various side effects. Weight gain has long been recognized as a side-effect of atypical antipsychotic (AP) drugs (Lieberman et al, 2005a). This AP side-effect has recently become a major concern in the treatment of psychosis because weight gain is a potential contributor to increased co-morbidity (Wirshing, 2001), including glucose intolerance, diabetes mellitus (Scheen& De Hert, 2007), metabolic syndrome (McEvoy et al, 2005) and cardiovascular diseases (Robinson et al, 2005). All of these conditions can lead to increased mortality (Wirshing, 2001). Furthermore, the fear of weight gain is one of the main factors contributing to poor compliance found in AP treatment (Perkins, 2002), so it may adversely affect the clinical outcome (Allison & Casey, 2001).Atypical antipsychotic agents, primarily Olanzapine and clozapine, have been associated with significant weight gain (Allison et al, 1999). The mechanism underlying weight gain induced by atypical antipsychotics has not been clarified, though Serotonergic, Noradrenergic and Histaminergic systems have been implicated (Baptista et al, 2002). The role of Histamine in the regulation has long been recognized. Animal studies have shown that food intake is suppressed by activation of the H-l receptor or inhibition of the H-3 receptor in the ventromedial hypothalamus or the paraventricular nucleus; both nuclei are involved in the regulation of satiety (Sakata et al, 1997). The H-2 receptor also appears to play a role in the regulation of feeding behaviours. The H-2 receptor antagonist, cimetidine has been reported to reduce weight in overweight healthy subjects (Stoa-Birketvedt, 1993), as well as in overweight patients with type II diabetes mellitus (Stoa-Birketvedt et al, 1998), although this finding has not been unequivocal (Birketvedt et al, 2000). Rodent studies suggest that the effects of H-2 antagonism on weight loss may be mediated by increases in cholecystokinin (Stoa- Birketvedt et al, 1997a, b), which implicates a gastric CNS feedback circuit in explaining H-2 putative weight-reducing effects. Medications with the potential for weight change, such as orlistat, amantadine and cimetidine, have been proposed to reduce antipsychotic-associated weight gain. This pharmacological intervention might bring about a relatively immediate and visible solution to this disturbing side effect, while it has the disadvantages of drug-interaction and its own adverse effects, so that general use is not recommended (Wemeke et al, 2002). There is a paucity of data about the role of the H-2 receptor antagonists in the management of atypical antipsychotic drugrelated weight gain. A recent study evaluated the efficacy of different doses of Ranitidine in preventing or reducing weight gain in patients with schizophrenia treated with Olanzapine in an open-label trial. According to their results, the use of Ranitidine prevented or corrected weight gain in 59.6% of the patients receiving Olanzapine (Lopez-Mato et al, 2003). This is the first study in India evaluating the putative weight attenuating effect of Ranitidine in schizophrenia patients treated with the atypical antipsychotic Olanzapine. Since young and previously untreated patients seem to be particularly vulnerable to Olanzapine induced weight gain (Kinon et al, 2001) we undertook this study to evaluate the efficacy of Ranitidine at two fixed doses of 150 mg 85 300 mg in patients of first episode schizophrenia. We also assessed the effect of Ranitidine on the parameters of metabolic syndrome and the laboratory parameters.

Background: Celiac Disease involves the small intestine patchily affecting more frequently the proximal small bowel but the histological changes have been observed till terminal ileum. Of late in addition to D2, the duodenal bulb (D1 region) biopsies have been found helpful in identifying a small group of patients with CD. Therefore, multiple site biopsies are recommended as histological changes are not uniform throughout small intestine. Methods: During this present 1.5 years prospective study, we evaluated 84 cases of suspected celiac disease with respect to the light microscopy (D1, D2, and D3 biopsy) and serology (anti tTg and or EMA). Histological examination was done according to Modified Marsh grading system. Results: Out of 84 cases with raised anti tTg, the segmental biopsies significantly increased the diagnostic accuracy from 39/44 cases (88.6%) to 43/44 cases (97.7%) and 44/44 cases (100%) when D2 alone, D1 + D2 and D1 + D2 + D3 biopsies were evaluated, respectively. Of the suspected cases of celiac disease patients (tTg > 10 ULN and associated weight loss, diarrhea), additional D3 biopsy increased the diagnostic yield by 2.1%, compared to D1, D2 region biopsy and 6.38% compared to standard D2 biopsy alone. Of the 28 cases (tTg > 10 times ULN + EMA positive and associated weight loss, diarrhea), the potential celiac disease (histologically Type 1/Normal) cases reduced from 28.5% (standard D2 region alone) to 21.4% and 17.8% when additional biopsies were taken from D1 region and D3 region, respectively, and additional D3 biopsy increased the diagnostic yield by 10.8% (compared to standard D2 biopsy alone) and 3.7% (compared to D1 and D2 biopsy). Conclusion: We believe multiple sites duodenal biopsies including D3 region biopsies might increase the diagnostic accuracy of adult celiac disease in addition to sensitive and specific serologic tests.