National Institute Of Mental Health And Neurosciences Research Articles

Integrated Yoga Therapy for mental Illness

Integrated Yoga Therapy for mental Illness

Clozapine-Induced Restless Legs Syndrome Treated With Aripiprazole

Clozapine-Induced Restless Legs Syndrome Treated With Aripiprazole

Broad-based with a cutting edge: The evolution and growth of NIMHANS

The National Institute of Mental Health and Neuro-Sciences (NIMHANS) in Bangalore, India began as the lunatic asylum, in 1848, when a separate asylum to care for the mentally ill was approved by Sir Mark Cubbon, Commissioner of Mysore in the Pettah area of Bangalore. After the transfer of power from the British to the Kingdom of Mysore in 1881, it became, for a while, the only asylum to be supported by a native kingdom. A larger mental hospital, in the light of the expanding population of Mysore, was thought essential by the 1920's, when the Maharaja of Mysore approved the decision to build a new asylum. This was finally completed in 1937, and by then had been renamed as the Mysore State Mental Hospital. The hospital, and its staff, was recommended as the first institution to begin training specialists in psychiatry and related mental health fields, after Independence, in 1953, when it was renamed the All-India Institute of Mental Health. It now houses the Department of Psychiatry at NIMHANS. The asylum architecture, horticultural layout, high standards of mental health care and emphasis on scientific training initiated in the early part of the last century continue to date and many of its alumni hold distinguished positions all over the world.

MP 6 Dementia: perspectives from developing countries

Dr Mathew Varghese is Professor of Psychiatry at the National Institute of Mental Health and Neuro Sciences (NIMHANS) at Bangalore, India. He did his training in Medicine at the St John9s Medical College, Bangalore and specialised in Psychiatry at NIMHANS in 1984. Since then he has been a faculty at the Department of Psychiatry, NIMHANS for over 25 years. His work at NIMHANS involves clinical services, postgraduate teaching, research and administration. At present he heads an Adult Unit, the Geriatric Clinic and Services and the Family Psychiatry Center at the Department. Dr Varghese9s areas of interest are psychogeriatrics, family psychiatry and rehabilitation. He has developed family intervention manuals for WHO projects for use with caregivers of persons with dementia and schizophrenia. He has been involved with research on dementia and since 1998 is one of the founding members of the International 10/66 Dementia Research Group and a member of the World Federation of Neurology Dementia Research Group. He was an investigator on the World Mental Health survey in India. At present he has many ongoing research projects supported by international and national agencies like the Fogarty International Center, the Wellcome Trust, the Department of Science and Technology and Dept of Biotechnology, India. He has over 70 publications in journals, monographs and books. Besides work at the NIMHANS he is a visiting faculty and examiner to other postgraduate courses in mental health. He is on the governing board of the World Association for Psychosocial Rehabilitation (India), the Alzheimer9s Disease International, the ARDSI and rehabilitation centers like the Richmond Fellowship Society (RFS) and the Medico Pastoral Association. He was the President, Indian Psychiatric Society (Karnataka State Branch) and is the Vice President, ARDSI (Bangalore) and the Secretary-General of the RFS India. He has also helped organise many conferences, symposia and workshops and was the Organising Secretary of the World Association for Psychosocial Rehabilitation World Congress 2009 at Bangalore. He is the National Coordinator for the National Dementia Strategy of the ARDSI and author of the Dementia India Report 2010.

Editorial introductions

Editorial introductions

Barriers to discharge of patients from a government-run day-care psychiatric rehabilitation center in India

ObjectiveMany psychiatric patients undergoing vocational training do not achieve successful transition to regular work. In this study, we evaluated the barriers for discharge from day care center to actual work place. Materials and methodsIn a cross-sectional study at a government-run day-care center at National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, we studied 76 patients who were undergoing vocational training for more than 1 year. We did a semi-structured interview with patients, their family members, and instructors of various occupational sections. We used a questionnaire of 17 different barriers to assess the obstacles in their discharge from day-care center to actual work place. ResultsThe majority of them had a diagnosis of mental retardation (n=47) followed by schizophrenia (n=29), and bipolar disorder (n=9). The mean (SD) age and duration of illness was 33.6 (9.7) years and 12.5 (9.3) years, respectively. Patients had more than one diagnosis. The median duration of stay in day-care center was 5.9 years. Doubts regarding performance at a new work place (n=60), fear of performance at new work place (n=65), and the fear of transition to regular work (n=64) were the most common barriers reported by patients, their family members and instructors of various occupational sections, respectively. DiscussionEducating patients and their family members, gradual exposure to new working environment, and increased community level vocational opportunities may potentially overcome above barriers. Getting them to the actual job early in their course of treatment will improve their adjustment to a new work place and overall outcome.

Expressed emotion and caregiver burden in patients with schizophrenia.

Background:Family's expressed emotion has been shown to be predictive of outcome in mental and physical illnesses in a variety of cultural settings. The relationship between caregiver burden and high level of expressed emotions has demonstrated a high level of relapse among the psychiatric patients in the West.Aim:The current study explores the relationship between caregivers’ burden and level of expressed emotions by the patients with schizophrenia in Indian setting.Materials and Methods:The sample for the study consisted of totally 70 subjects comprising 35 schizophrenic patients and 35 caregivers. The schizophrenic patients who were attending the Day Care Center run by Department of Psychiatric and Neuro Rehabilitation Unit at National Institute of Mental Health and Neuro Sciences (NIMHANS) in Bangalore, India (a tertiary care center) and their primary caregivers were included. Family emotional involvement and criticism scale and The burden assessment schedule were administered to assess the expressed emotions and caregivers’ burden. Carl Pearson Correlation test used to study the relationship between the variables.Results and Conclusion:The study highlighted the need for addressing expressed emotion in comprehensive psychosocial intervention plan. More attention should be paid to the needs of the caregivers in order to alleviate their burden in managing mentally ill patients.

Current status of behavioral medicine research and practice in developing countries

aCommunity, Culture and Mental Health Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Perth, Australia bDepartment of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India Correspondence to Professor Mohan Isaac, MD, FRCPsych, FRANZCP, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Level 6, W Block, Fremantle Hospital, 1 Alama Street, Fremantle, WA 6160, Australia Tel: +61 8 9431 3474; fax: +61 8 9336 5505; e-mail: [email protected]

Of Postures, Mirrors, and Models in Catatonia

Back to table of contents Previous article Next article LettersFull AccessOf Postures, Mirrors, and Models in CatatoniaUrvakhsh Meherwan Mehta, M.D., Narayana Manjunatha, M.D., D.P.M., and John P. John, M.D.Urvakhsh Meherwan MehtaSearch for more papers by this author, M.D., Narayana ManjunathaSearch for more papers by this author, M.D., D.P.M., and John P. JohnSearch for more papers by this author, M.D.Published Online:1 Jan 2011AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Posturing in catatonia is one of its more distinctive phenomena, the bizarreness of which has fascinated psychopathologists, clinicians, and researchers alike. Fish1 describes posturing as a disorder of goal-directed movements. Cutting2 ascribes it to a disintegration of purposeful actions and gives it a status of pseudo-purposefulness. We report a case of catatonia that presented with a wide range of posturing, involving groups of muscles from head to toe, and we highlight the relevance of a broader conceptualization of posturing and newer research forays based on fundamentals of motor cognition.Case ReportA 26-year-old man from southern India with unremarkable past, personal, and family history presented with illness lasting 8 days that had abrupt onset and polymorphic course. Symptoms appeared in the sequence of paranoid delusions and extreme psychomotor excitement, and over the next 2 days, he displayed florid catatonic features, the most dramatic of them being demonstration of an array of posturing signs from head to toe.The patient's face displayed grimacing (due to facial muscle spasm giving an appearance of a sneering grin like that of risus sardonicus) and motor stereotypies of his lower jaw with instances of spasms in his jaw muscles leading to trismus. Staring was evident, with fixed gaze and poor blink rate. Stereotyped posturing was observed in the neck and shoulder muscles as he lay supine in bed with his head a few inches off the pillow (psychological pillow) and in the extensor spinal muscles which led to episodic and recurrent opisthotonus or arc de cercle. Classical mannerist posturing involving the upper limbs was evident, with his arms spontaneously held in a prayer-like folded manner (namasthe in Indian culture). Catalepsy or perseveration of posture was observed in both upper and lower limbs when placed in a series of uncomfortable postures. The posturing display occurred in episodes lasting 1–20 minutes over a period of 36 hours. There was no historical account of being administered neuroleptics. Examination did not reveal neurological deficits. Despite extensive metabolic, imaging, and EEG investigations, no organic pathology was demonstrated. The patient improved with ECT after partial response to lorazepam.DiscussionIt has been more than a century since Kahlbaum3 described catatonia as a syndrome of motor abnormalities, yet it remains a poorly understood phenomenon. Novel methods based on fundamentals of cognitive and social neurosciences may shed some light on neurobiology of catatonia. We propose a broader conceptualization of posturing as a prototype motor dysregulation state based on recent advances in mirror neurons and motor cognition. The increasing understanding of neural circuits underlying motor cognition domains of intention (presupplementary motor area and intraparietal sulcus),4 initiation (supplementary motor area),5 termination (right posterior parietal cortex),6 implicit motor feedback for execution (anterior cingulate),7 sense of agency and gnosis of these phenomena (mirror neurons of inferior parietal lobule, pars opercularis of inferior frontal gyrus and insula)8 is an exciting development. These concepts can be utilized in formulating a composite cognitive model of catatonia which can then be empirically tested.Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India1. Casey P , Kelly B: Motor disorders, in Fish's Clinical Psychopathology: Signs and Symptoms in Psychiatry, 3rd Edition. Edited by Casey PKelly B. Cambridge, UK, Gaskell, 2007Google Scholar2. Cutting J: Principles of Psychopathology: Two Worlds, Two Minds, Two Hemispheres, 3rd Edition. Oxford, UK, Oxford Univ. Press, 1997Google Scholar3. Kahlbaum KL: Catatonia. (trans. , Levi Y , Pridon T). Baltimore, MD, Johns Hopkins Univ. Press, 1973Google Scholar4. Haggard P: Conscious intention and motor cognition. Trends Cogn Sci 2005; 9:290–295Crossref, Medline, Google Scholar5. Jahanshahi M , Jenkins IH , Brown RG, et al.: Self-initiated versus externally triggered movements. I. An investigation using measurement of regional cerebral blood flow with PET and movement-related potentials in normal and Parkinson's disease subjects. Brain 1995; 118(part 4):913–933Crossref, Medline, Google Scholar6. Northoff G: Catatonia and neuroleptic malignant syndrome: psychopathology and pathophysiology. J Neural Transm 2002; 109:1453–1467Crossref, Medline, Google Scholar7. Berns GS , Cohen JD , Mintun MA: Brain regions responsive to novelty in the absence of awareness. Science 1997; 276:1272–1275Crossref, Medline, Google Scholar8. Rizzolatti G , Fabbri-Destro M , Cattaneo L: Mirror neurons and their clinical relevance. Nat Clin Pract Neurol 2009; 5:24–34Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 23Issue 1 Winter 2011Pages E16-E16 Metrics PDF download History Published online 1 January 2011 Published in print 1 January 2011

Neuropsychological Lateralization of Brain Dysfunction in Children With Mesial Temporal Sclerosis: A Presurgical Evaluation

Presurgical evaluation of children with mesial temporal sclerosis has shown severe neurocognitive impairments. There is debate about lateralized material-specific deficits in memory in children with mesial temporal sclerosis. The authors examined lateralization of brain dysfunction and age appropriate development of cognitive functions in 17 children (7-15 years) with mesial temporal sclerosis who had histories of uncontrolled epilepsy. The National Institute of Mental Health and Neurosciences (NIMHANS) neuropsychological battery for children was employed and each participant's performance was compared with the norms. Results showed that the battery was sensitive to deficits in learning and memory associated with mesial temporal sclerosis. However, a lack of clearly lateralized material-specific memory deficits in children with left/right mesial temporal sclerosis was also observed. Performance on tests that assess learning, attention, working memory, and visuospatial functions was found to be below the age appropriate level. Children with mesial temporal sclerosis showed widely distributed neuropsychological deficits.

Perceptions of HIV Risk Among Monogamous Wives of Alcoholic Men in South India: A Qualitative Study

To understand women's perceptions of their own HIV risk and to determine the feasibility of conducting an HIV prevention study. Two focus groups were conducted in November 2004 with wives of heavy drinkers admitted to the Deaddiction Unit at the National Institute of Mental Health and Neurosciences (NIMHANS) in Bangalore, India. Data were analyzed using content analysis. Results focused on (1) awareness of the women regarding HIV/AIDS and condom use, (2) perception of personal risk for HIV/AIDS and the risk of their spouses, and (3) the feasibility of a future community-based HIV prevention study. Focus group findings indicated that although the majority of the women were aware of HIV/AIDS, there were important misconceptions about the mode of transmission. Women acknowledged the potential risk for HIV associated with their spouse's drinking, as well as their extramarital sexual activities, but expressed an inability to negotiate safer sex behaviors, such as condom use, within the context of marriage. This was often expressed as fear of being physically abused for attempting such negotiations. All women agreed that the HIV prevention study we proposed, originally developed in the West, would be acceptable if tailored to specific local needs. The women provided valuable suggestions for the effective implementation of the study. The findings of this study indicate a critical need to develop culturally relevant HIV prevention programs directly targeted to wives that equip them with effective skills to negotiate safer sex behaviors with their spouses.

An overview of Indian research in obsessive compulsive disorder

Obsessive-compulsive disorder (OCD) was considered a relatively rare disorder until about two decades ago. Since then, considerable advance has been made in understanding the various aspects of OCD that include epidemiology, clinical features, comorbidity, biology and treatment. In the last one decade, there has also been interest in a group of related disorders called obsessive-compulsive spectrum disorders. There is substantial research from India on various aspects of OCD, particularly from the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore. We attempt to review all the relevant Indian data on OCD.

Boundary debates: The new challenge of psychiatry

Byline: Philip. John Changing Boundaries Boundary between Behavior and Biology is arbitrary and changing. It has not been imposed by the natural contours of Disciplines, but by lack of knowledge at the time (E.R. Kandel) Body-Mind Dualism The boundary, the dichotomy between body and mind held sway for a long time. This Cartesian dualism achieved a shrewd truce between the church in the 17[sup] th century and science, by partitioning body and mind into two domains. Such a dichotomy then appeared logical - what was 'visible' went to science and what then was 'invisible' went to the church and the charlatans. This shrewd and clever truce enabled spectacular progress in all other disciplines of medicine except the 'science of mind', which simply could not have progressed asking more of philosophical and sociological questions than biological.[sup] [1] Even as the science of mind subsequently progressed, its boundaries have been under perpetual violation and incursion - by empiricisms in the past decades, and 'overlapping' fraternity at present because we cannot, as yet, clearly define this business of 'mind'. With the exponential technology available today that creates windows to 'peep' into live brain cells as they go about performing the mental functions, the mind may appear as arising purely from physical processes such as electrical signals or complex cellular chemicals. On a different plane, the mind transcends the physical, as something evanescent and ethereal that may be closer to the philosophical or spiritual concept of the soul! So, here we are - does the soul belong in psychiatry, neuro-theology, philosophy or theology? The boundaries are still indistinct as indubitably expressed by Prof. Mike Trimble, Professor of behavioral neurology at the Institute of Neurology, London, in his recent book - 'The Soul in the Brain'. However, when your temperament and training are right, if you open up a brain, the mind will eventually fall out.[sup] [2] Psychology and the Isolation of Psychiatry The dualism between psychology and psychiatry too is a derivative of the faded mind-brain issue, which once created professional contest and personal vanity within the field of behavioral sciences. Psychiatrists must never discard or diminish the environmental influences in the etiopathogenesis of psychiatric disorders. Nevertheless, those in our own profession who pretend that psychiatry is not a branch of medicine, in order to facilitate 'multi-disciplinary approach', contributed to the abysmal isolation of psychiatry from the rest of medicine.[sup] [3] As a consequence, even physicians sometimes fail to distinguish psychiatrist from a psychologist! While training at National Institute of Mental Health and Neuro Sciences (NIMHANS), many in our generation went through these boundary tensions. But fortunately, those were related to 'hierarchical' disputes and the movement that we then spearheaded settled those issues once and for all. Even in a multi disciplinary system, the hierarchical order cannot be compromised at any cost; in fact hierarchy only strengthens a holistic approach to management.[sup] [4] Technology has transformed the operating boundaries between psychology and psychiatry in the clinical practice of medicine, and ended psychiatry's isolation. Mind being generated by the nervous system, we discern that psychiatry is a pure branch of medicine. Psychiatry should be perceived and practiced as application of basic neurosciences to man's day-to-day problems.[sup] [1] Therefore, psychiatrists are primarily physicians. Period. Boundary between Behavior and Biology Expanding knowledge of the roots of behavior in neurobiology is fast merging frontiers and obliterating boundaries between related disciplines such as neurology, psychiatry and pediatrics. As Kandel implied, the arbitrary boundaries between behavior and biology are not imposed by contours of the medical disciplines. …

Psychosocial Care for Women Survivors of the Tsunami Disaster in India

I investigated the effectiveness of Psychosocial Care, a community-based mental health initiative for survivors of the 2004 tsunami disaster in India. Mental health teams from the National Institute of Mental Health and Neurosciences (NIMHANS) in India implemented a train-the-trainer model of psychosocial care in one of the worst tsunami-affected areas of south India. Three months of psychosocial care was provided for an intervention group of women, but not for a control group recruited from an exposed neighboring village. Impact of Event Scale (IES) scores--both total scores and scores for subscales on hypervigilance, avoidance, and intrusion--were compiled for both the intervention and control groups and used as outcome measures. For the intervention group, posttest total IES and subscale scores were significantly lower than pretest scores (P < .001), indicating improvement in symptoms. Posttest total IES and subscale scores were significantly lower for the intervention group than for the control group (P < .001). Psychosocial care is an effective mental health strategy for women survivors of disasters and should be an integral component of disaster response in resource-poor countries.

Treating Mania in Wilson's Disease with Lithium

Treating Mania in Wilson's Disease with Lithium

Treating Mania in Wilson’s Disease with Lithium

Received April 11, 2007; revised June 5 and July 11, 2007; accepted July 30, 2007. Drs. Loganathan, Nayak, Math, and Varghese are affiliated with the Department of Psychiatry at the National Institute of Mental Health and Neurosciences (NIMHANS) in Bangalore, India. Drs. Sinha and Taly are affiliated with the Department of Neurology at NIMHANS in Bangalore, India. Address correspondence to Dr. Santosh Loganathan, Department of Psychiatry, NIMHANS, Hosur Rd., Bangalore, Karnataka, 560038, India; santoshl_28@yahoo.co.in (e-mail). Copyright 2008 American Psychiatric Publishing, Inc. Treating Mania in Wilson’s Disease with Lithium

The association between attention-deficit/hyperactivity disorder and early-onset alcohol dependence: A retrospective study

Background:Early onset (EO) alcohol dependence (AD) has been found to represent a subtype of alcoholism with a distinct profile and prognosis compared to late onset (LO) alcohol dependence. Externalizing disorders, especially attention deficit hyperactivity disorder (ADHD) that may continue as attention deficit hyperactivity disorder, residual type (ADD, RT) in adulthood, may increase susceptibility to early-onset AD.Aims:To examine the relationship between ADHD and ADD, RT symptoms and age at onset of AD in a sample of Indian male patients. 70 male subjects with AD presenting to the De-Addiction Services of the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, were studied. The study had a retrospective design.Materials and Methods:Patients were examined for evidence of past ADHD in childhood and current ADD, RT using structured instruments. Chi-square tests and odds ratios were used to express the relative risk of association of ADHD with early- and late-onset AD.Results:Significantly more EO alcoholics (19/30, 63.3%) had a history of ADHD in childhood compared to LO alcoholics (7/28, 25%, P < 0.05) ADD, RT was also over-represented in EO probands.Conclusions:The results of this study are consistent with previous research that shows a high incidence of ADHD in early-onset alcoholics. This may have important management implications.

Experiences of stigma and discrimination endured by people suffering from schizophrenia.

Objective:It is important to understand stigma in India, given its varied culture and mixture of rural and urban populations. Information from western literature cannot be applied without considering the sociocultural differences.Aims:The research aimed to study the subjective experiences of stigma and discrimination undergone by people suffering from schizophrenia in rural and urban environments in India.Settings and Design:Patients were selected from the outpatient services of six adult psychiatric units of the National Institute of Mental Health and Neurosciences (NIMHANS), India, and from the six outreach centers located in rural areas.Materials and Method:Two hundred patients diagnosed with schizophrenia were selected from rural and urban areas. The experiences of stigma and discrimination were assessed using a semi-structured instrument.Statistical Techniques:Both quantitative and qualitative analyses were done.Results:Significant differences were seen between rural and urban respondents. Urban respondents felt the need to hide their illness and avoided illness histories in job applications, whereas rural respondents experienced more ridicule, shame, and discrimination. The narratives provide direct views of patients, supporting the key findings.Conclusion:Mental health programs and policies need to be sensitive to the consumers’ needs and to organize services and to effectively decrease stigma and discrimination.

Cardiac autonomic dysfunctions in chronic refractory epilepsy

Background Sudden unexplained death is an important cause of mortality in patients with epilepsy and cause for this is not fully understood. One of the explanations is autonomic dysfunction (AD). Studies of AD in chronic refractory epilepsy are very few in the literature. Aim To evaluate cardiovascular autonomic functions in chronic refractory epilepsy patients. Methods and materials Seventy-three patients (31.5 ± 9.8 years, M:F::45:28) with chronic intractable epilepsy attending the “refractory epilepsy clinic” at a tertiary referral center (National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India) were enrolled. Age and gender matched healthy subjects were recruited as controls. Heart rate (HR) and blood pressure (BP) at rest and HR response after deep breathing, Valsalva maneuver, postural change and BP response to postural change and isometric work were recorded. AD was graded as early if one of HR or BP, definite if two or more HR and severe if two or more HR with BP based tests were detected to be abnormal. Results The mean age at onset and duration of epilepsy was 12.4 ± 8.5 years and 19.02 ± 9.07 years, respectively. Twenty-three (31.5%) patients of refractory epilepsy had early involvement while 25 patients (primary generalized: 8, partial: 17) had Definite AD, and 16 (primary generalized: 4, partial: 12) had severe autonomic dysfunction. ANCOVA results showed expiration–inspiration, standing maximum:minimum ratio, standing 2 min systolic and isometric diastolic BP of the dysfunction group significantly differ compared to the control group. Patients with longer duration of epilepsy (23.2 years) had more severe dysfunction ( p < 0.05) than patients with relatively shorter duration (17.5 years) of epilepsy. Antiepileptic drugs (AED) used did not show any significant role on autonomic functions in this study. Conclusion This is the first study from India to evaluate autonomic functions in refractory epilepsy patients. Autonomic dysfunction was noted in 56.3% of patients. Anticonvulsants used were not associated with AD. Longitudinal controlled studies with ‘newly diagnosed’ epilepsy patients will enhance further understanding about the role of autonomic system in epilepsy.

Is bipolar II disorder misdiagnosed as major depressive disorder in children?

Objectives: To estimate the lifetime prevalence of bipolar II disorder in children and adolescents presenting with DSM-IV major depressive disorder (MDD). Methods: Sixty-one consecutive subjects aged ≤ 18 years attending the outpatient services of the Child and Adolescent Psychiatric (CAP) services of the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India with a diagnosis of MDD were evaluated using the Missouri Assessment of Genetics Interview for children (MAGIC). Two psychiatrists, one of whom was a child psychiatrist diagnosed hypomania by consensus. Results: Twelve children had a past episode of hypomania (20%), which was hitherto undiagnosed clinically. Limitations: We recruited subjects from a psychiatric hospital, thus limiting the generalizability of the finding. Sample size was relatively small and assessments were cross-sectional. Conclusions: Our study shows that bipolar II disorder is often misdiagnosed as MDD in children. The study also highlights that the chance of diagnosing bipolarity is enhanced by using semi-structured interview in routine clinical practice.