An overview of psychiatry during the last three decades as practised in a general teaching hospital is presented. Psychiatry as an academic subject has matured tremendously during this period. The empirical treatments of the 1950s and the 1960s which evoke nostalgic memories, have been replaced by modern methods of treatment. However, there is a need to exercise caution against the blind acceptance of new and sophisticated research findings in biological psychiatry. Inspite of the bright future facing psychiatry, the identity of psychiatry as a medical discipline must be preserved at all cost. Psychiatrists should also realise the dangers of gradual fractionation and impersonalisation which threatens the speciality, and makes all possible efforts to prevent this.

Monitoring levels ofpsychopharmacological agents for the purpose of optimising treatment is being recommended for increasing number of situations in routine psychiatry practice by some western authors. As a result most psychiatrists in developed countries advise drug assays for many patients on psychopharmacological treatment. Even in developing countries like India, therapeutic drug monitoring (TDM) is being advised more frequently, thus creating a demand for facilities. This paper reviews the need & feasibility of TDM in developing countries focussing on cost effectiveness, ethnopharmacological and sociocultural issues. Recommendations are made for using TDM in developing countries only in certain specific & selected clinical situation. Cost-effectiveness of strict serum lithium monitoring is discussed from a community health point of view.

Neuroleptic induced neurological side effects were compared over a period of one year (1991-1992) in 45 schizophrenics and age and sex matched 42 mood disorder patients, diagnosed as per DSM-III-R criteria. Prevalence of dystonia was equally common in both groups. Pseudoparkinsonism was significantly high in female mood disorder patients, akathisia in middle aged mood disorder patients and tradive dyskinesia in mood disorder patients. Factors like age of onset, time of onset and mean dose of antipsychotics (chlorpromazine equivalent) did not show any significant difference. The findings are discussed in relation to their practical application and suggestions for future studies are outlined.

Fifty schizophrenic patients fulfilling DSM-III-R criteria, and group matched normal healthy controls were selected for the study The case and control groups have been compared in terms of VBR, WSF and WTF. In the study schizophrenics have been divided into positive, negative and mixed subgroups on basis of SAPS and SANS, and these subgroups are compared with each other for VBR, WSF & WTF. Tomographic abnormalities were noted in schizophrenics, particularly with negative and mixed subtypes, when compared to controls.

A door to door field-survey was conducted in two villages by a team of psychiatrists with the aim of assessing the mental morbidity of the population. The present communication is restricted to the mental morbidity of the elderly population aged 60 years and above. The total sample comprised 183 persons (male 85, female 98). Majority of the families (44.2%) belonged to class IV according to Pareek and Trivedi's scale. Sixty one percent of the elderly population was mentally ill. Women had a higher rate of morbidity than men (77.6% and 42.4% repetitively). The overwhelming majority of the affected persons were depressives. Rate of dementia was low.

Psychiatric morbidity in primary rural school children (n=460) was studied with the use of Rutter-B-Scale, a screening instrument. Overall prevalence was found to be 33.3 percent. Conduct disorder was found to be the commonest diagnostic category with a prevalence rate of 13.5%. This was followed by mental retardation with a rate of 5.4%, enuresis 4%, simple disturbance of activity and attention 3.1%, and relationship problem 2.7%. The results have been discussed in a cross-cultural perspective.

The apparent rationale for the popular use of high doses of neuroleptics in psychotic patients is to increase the degree and speed of therapeutic response .However, several recent reports have questioned these claims. The present study was undertaken with the aim to compare the efficacy of high and low oral doses of haloperidol in the treatment of acute and transient psychotic disorders. The sample comprised of forty patients of both sexes diagnosed as acute and transient psychotic disorder who were randomly assigned to high dose (20 mg/day) and low dose (5 mg /day) haloperidol groups with equal number of subjects (n=20) in both groups. Weekly assessment was done on Brief Psychiatric Rating Scale and Haloperidol Side-effects Check List (day 7, 14, 21, 28, 35 & 42). Both groups showed significant improvement in BPRS from baseline scores on all assessments. Comparison of the improvement rate in both study groups revealed no significant difference.

A survey on opium use was earned out in Tinsukia district of upper Assam to assess the present prevalence and pattern of opium abuse and compared with earlier findings of the year 1981 (Baruah et al., 1995). A total of 75 addicts could be detected during the survey and 61 were interviewed using structured questionnaire. The results indicate significant decline in prevalence in opium use over the years in all the villages under high prevalence area. Out of 61 addicts, 51 addicts had started taking opium before 1980 and only 10 new addicts were added by 1990. The trend analysis of opium user's from 1979 to 1995 indicates a linear trend with high rate of decline in opium addicts statistical analyses, supports the hypothesis that linear declining trend is the best fit. By 1995, only four addicts were found having continued taking of opium.

The original tricyclic antidepressant drugs are consistently underused in major depression because of side effects, delayed onset of action, and potential for overdose. In an open study of 6 weeks' duration, we studied the efficacy and acceptability of amineptine, a dopamine reuptake inhibitor, at fixed dose of 200 mg per day in 50 patients with major depression. Intention-to-treat analysis showed a patient response rate of 64% (95% CI 77-50) in HDRS, 62% (95% CI 75-48) in MADRS, 46% (95% CI 59-32) in ZUNG scale, 52% (95% CI 66-38) in Social Activity scale, and 26% ("95% CI 38-14) in CGI-severity of illness after 7 days treatment. Response in CGI-global improvement was 38% (95% CI 51-25), and in CGI-efficacy index 48% (95% CI 62-34) after 14 days of treatment. With continued therapy, only CGI-severity of illness showed a significant increase in response rate after 42 days. The treatment effect of amineptine was reflected in a significant and progressive improvement in all depression, social activity, and CGI rating scale scores throughout the study period. Somatic symptoms and side effects assessed by AMDP-5 showed significant improvement at each assessment. The clinically useful response in depression which occurred by the first week of treatment, favourable side effect profile, and the convenience of a fixed dose could make amineptine a suitable first line alternative for the treatment of major depression.

This study was designed to assess the relationship between psychopathology and serotonin generated prolactin response to clomipramine and to assess the relationship between improvement in psychopathology and prolactin levels. The experimental sample consisted of 15 patients in the drug and 12 patients in the placebo groups. Blood samples for prolactin levels were drawn at baseline, and at the end of 4,8, and 12 weeks. There were statistically significant differences in prolactin increase between the drug and the placebo groups at 4 but not at 12 weeks following treatment. When the four least improved and a similar number of the most improved patients were compared, the least improved patients had the most increase in prolactin and the most improved had the least increase.

51 patients who were admitted for their first manic episode were followed up for 4 years after discharge from the hospital. 32 (62.7%) patients came for regular follow-ups whereas 19 (37.3%) patients did not come for any follow up. 19 (59.4%) patients out of the 32 patients had subsequent recurrences. 8 (25.0%) patients had a single recurrence only, whereas 11 (34.4%) patients had multiple recurrences. In total, 31 (74.19%) recurrences occurred in 4 years, out of which 23 (25.81%) recurrences were for mania and only 8 for depression. 46.88% patients had relapsed at the end of the first year and by the third year all 19 (59.4%) patients had relapsed. The chances of having a depressive episode was highest in the first six months after recovery from manic episode. Patients with a family history of bipolar illness had a more deleterious course. Poor drug compliance was a factor associated with greater relapse rates. Amongst the patients receiving regular medication, the patients who were on lithium had the best outcome. 48.8% patients had subsequent admissions in the four year follow up. Patients with late age of onset and substance abuse had required greater number of admissions.

Presumptive Stressful Life Events Scale (PSLES) was administered to 69 physically ill, 23 patients with somatoform disorders and 45 patients with psychiatric disorders other than somatoform disorders who sought medical help in primary health care settings. The 137 patients were cluster analysed in orderto obtain the patterns of distribution of 39 life events. Five clusters emerged. All the patients in cluster Vhad somatoform disorders and life events had a significant occurrence and discrimination.

Although neuroleptic malignant syndrome manifests consistently with hyperthermia, muscle rigidity, altered mental status, and autonomic instability, heterogeneity exists in the onset, course, laboratory findings, response to treatment and pattern of resolution. Comorbid physical conditions tend to confuse the picture. We report a case of NMS with one such presentation.Although neuroleptic malignant syndrome manifests consistently with hyperthermia, muscle rigidity, altered mental status, and autonomic instability, heterogeneity exists in the onset, course, laboratory findings, response to treatment and pattern of resolution. Comorbid physical conditions tend to confuse the picture. We report a case of NMS with one such presentation.

The rabbit syndrome, a neuroleptic induced extrapyramidal side effect with Vafe onset, consists of rapid fine rhythmic movements of the lips that mimic the chewing movements of a rabbit. This syndrome was first described by Villeneuve in 1972. Unlike the buccolingual movements of the tardive dyskinesia, the rabbit syndrome improves with antiparkinsonian medication. The condition is reported to be rare. To the best knowledge of the author, no case has been described or reported from India. A case of rabbit syndrome is described with review of the literature.

A case of obsessive-compulsive disorder (OCD) is presented in which the chief symptom was obsessive musical imagery. Such musical obsessions are not described in standard texts of psychiatry or phenomenology, or in articles on OCD; nor are they considered in diagnostic procedures for OCD. Either the symptom is rare, or it is unnoticed because of low clinical awareness.