There has been a decline in the rural population of India from nearly 82% to about 65% over the past six decades. The National Mental Health Survey of India (2015–2016) reported a lower prevalence of mental disorders in rural areas compared with urban ones. Mental health services in the country are skewed towards the urban areas, and more families are pushed below the poverty line while getting treatment for a member with mental illness. India has expanded its District Mental Health Programme over the past two decades, and it now covers nearly all the districts in the country. Despite that, significant numbers of people with mental disorders, ranging from 70–90%, do not receive adequate treatment. This paper discusses the rural–urban divide in the mental health services, examining the problem and need, and the initiatives taken by the government of India in this direction.

Psychiatric sequelae may occur following traumatic injury irrespective of whether an insult has been caused to the brain. A range of psychiatric illnesses have been either causative of or associated with road traffic accidents and traumatic injuries, including depression, anxiety, post-traumatic stress disorder, substance use disorder and attention-deficit hyperactivity disorder. Despite literature on such associations, psychiatric intervention in the treatment of patients following traumatic injury is limited. The authors share their experience of challenges in addressing mental health problems in a tertiary care trauma centre located in North India. Steps in overcoming those challenges included: developing a semi-structured form to be completed for referrals and consultations, a psychiatrist attending weekly rounds with the surgeons, and initiating a psychiatry out-patient clinic for patients discharged from the trauma centre. It may be worthwhile in the future to set up a trauma psychiatry unit at the centre, involving a clinical psychologist, a psychiatric social worker and an occupational therapist for the comprehensive care of patients.

This paper discusses the influence of the Mental Healthcare Act 2017 on mental healthcare in India. The new Act was introduced to meet the recommendations of the United Nations Convention on the Rights of Persons with Disabilities. Reforms proposed in the new legislation, challenges in their implementation and their effects on mental healthcare in the country are further discussed.

Patients presenting to psychiatrists frequently have comorbid medical conditions for which they are receiving treatment. A range of medications used for treatment of these conditions can have adverse effects resembling psychiatric symptoms. This article presents the results of our review of the literature on psychiatric adverse effects of various non-psychotropic medications, and discusses the mechanisms of such effects, their assessment and management. Among the commonly prescribed drugs found to have psychiatric adverse effects are corticosteroids, anti-Parkinsonian drugs, anti-epileptics, antiretrovirals, antibiotics, anticancer drugs, analgesics, drugs targeting endocrine and cardiovascular disorders, immunosuppressants, skeletal muscle relaxants and bronchodilators. Some adverse effects are predictable and dose dependent, whereas others are rare and idiosyncratic, and psychiatrists need to be aware of them for accurate diagnosis and appropriate treatment.

In South Asia, general hospital psychiatric units (GHPUs) have developed as an alternative to mental hospitals for the provision of comprehensive mental health services, training and research. GHPUs provide clinical care for all types of patients, including those with severe mental illnesses (SMIs). However, psychosocial rehabilitation is often neglected in GHPUs, partly because of the predominance of the medical model in routine clinical care and a lack of resources. This paper discusses the challenges in the management of SMIs in GHPUs and proposes a model of psychosocial rehabilitation which could be used in such settings.

Ninety-five schizophrenic patients were assessed using the Present State Examination, the Brief Psychiatric Rating Scale and the Scale for the Assessment of Negative Symptoms. Negative and depressive symptoms were frequent, and significant relationships among negative symptom complexes and depressive syndromes were noted. Retardation, lack of energy, slowness, and other symptoms of depression were significantly associated with the negative symptoms of schizophrenia. Depressed affect per se did not have a significant correlation with negative symptoms.