There is a growing recognition among mental health professionals of the need for more ethnographic studies on local mental health needs, conceptions, and resources in order to formulate more culturally-informed and effective therapeutic strategies at the health-care planning and policy levels. R.L Kapur(1992), for instance, underscores the need for detailed family ethnographies on behavioural patterns and intra-familial relationships, especially in the wake of the changes brought on by industrialisation, urbanisation and modernisation in the Indian context. The present paper is a micro-analysis of the ways in which chronic mental illness in a female member is managed by a lower middle-class urban family in Delhi. Through a single case illustration. I argue how a general hospital psychiatry unit may emerge as the only viable option for periodic reprieves for both patients and families in the absence of adequate and acceptable state-sponsored facilities for long-term management of chronicity.

Thirty patients suffering from schizophrenia (diagnosed as per DSM-IV criteria), for more than 2 years and having predominant negative symptoms were started on risperidone (2-10 mg/day) and were followed up over a period of 16 weeks. The improvement was assessed using PANSS (Positive and Negative Syndrome Scale). During this 16 weeks follow up, it was interestingly noted that though there was a significant improvement in negative symptoms in all the patients, in 7 patients there was a reemergence of positive symptoms. Four patients had increase in rating on suspiciousness and hostility and two patients reported auditory hallucinations. One patient developed delusions and conceptual disorganization along with suspiciousness and hostility.

Pharmacological intervention is the commonest mode of managing patients with schizophrenia. Both clinicians and patients are concerned that antipsyohotic drugs are costly and contribute to poor drug compliance in India. This study compared the equivalent doses of antipsychotic drugs and their costs across brands. Results show that antipsychotic drugs are affordable and are comparable to drug treatment costs of other physical illnesses. However, coprescription of drugs add to the burden. Numerous brands and a 2-2Vz fold difference in cost raises many concerns including that of drug bioavailability. Hence, the authors recommend consensus and formulation of guidelines for the pharmacological management of schizophrenia.

Six well investigated patients of primary hyperphagic obesity with hypochondrical disorder were sequentially treated with psychoeducational methods alone and psychoeducational methods with naltrexone hydrochloride 50 mg daily orally for six weeks each. RMANOVA revealed no statically significant (p>0.05) decrease in body mass index suggesting that psychoeducational methods with naltrexone were as ineffective in reducing obesity as psychoeducational methods alone. The limitations of the study and implications for future research are discussed.

A prominent relationship has been proposed between compliance and various factors, like the patient's individual characteristics, the illness and medication being prescribed to the patient. We compared 20 manic patients who were non compliant to medication with a control group, who were matched on the demographic variable, illness variables and the treatment prescribed. We first examined the reason for non compliance from the patient's perspective, and found out the commonest reason for non compliance to be 'side effect of the medicines' (35.0%), followed by the sense of 'feeling well' (30.0%). On assessing the patient's personality traits using 16PF, we found significant elevation on factor L, signifying characteristics like pretension, jealousy, suspiciousness etc. On the DMI, the patients got significantly lower scores on the variable PRN - indicating less use of defenses like inteilectualization and rationalization. Based on these findings we came to the conclusion that noncompiiant patients use less of mature defenses and more of primitive defenses.

In a retrospective descriptive study of hyperkinetic conduct disorders (HCD) and conduct disorders (CD), as per ICD-10 diagnostic criteria, their clinical and phenomenological correlates were compared; with an aim of describing their distinctive clinical profiles. 20 cases of HCD and 25 cases of CD were compared on socio-demographic variables, temperament and specified clinical variables. The two groups differed in terms of the HCD group having younger age of onset, a more gradual development of and longer duration of conduct symptoms as compared to CD children. HCD children also had temperamental deviance (in the form of inattention, distractibility), lower IQ, more perinatal complications and delayed milestones as compared to the CD group; which made significant contribution to discriminant functions between the two groups. Results point towards different pathways of development of conduct symptomatology in HCD group as compared to the CD group

The aim of the present study was to determine the severity and relationship of depression, hopelessness & sucide intent in individuals attempting suicides. Individuals admitted to a northern India hospital emergency services between 1st Jan. '94 to 31st Dec. '94 with suicide attempt were taken up for study and assessed with the help of different tools. 79 patients were screened for the study and 56 patients were included (33 male & 23 female). Majority of the sample was below 30 years of age (82.1%). Organophosphorus consumption and drug overdose was most common (75%) psychiatric illness was present in 57% cases, depression being most common 37.5% (p<0.001) 22 subjects showed mild to moderate suicide intent (39.28%) & 16% subjects showed hopelessness score above 9. Variables taken up for the study have a highly significan correlation with each other i.e. suicidal intent, hopelessness and depression.

There are clearly documented evidence concerning violence by the mentally ill. The violence may be committed on the basis of delusional beliefs or exacerbation of symptomatology. Family members have been the object of violence in more than 50% of the cases. It is not surprising, therefore, that patients are brought restrained to the psychiatric treatment units. This study was thus conducted to find out whether the perceived aggression by the guardians was the same as the manifest aggression by the patient. 53 consecutive, drug free, psychotic patients attending the C.I.P. O.P.D. for the first time were rated on Social Dysfunction and Aggression Scale (SDAS- 9) to measure quantum of aggression and the Brief Psychiatric Rating Scale (BPRS) to assess the psychopathology. The patients were diagnosed using the criteria laid down in ICD X. BPRS score was significantly higher in schizophrenics as compared to other diagnoses (one way ANOVA, p=0.005). Although there was no difference in the aggression scores in different diagnostic categories, manics were significantly more likely to be restrained (x ² test, p=0.04).

Epidemiology and the study of subtypes of delusional disorders is a poorly researched area. This study tries to fill this lacuna and provides the evidence contrary to the accepted fact that the persecutory type is the most common subtype of persistent delusional disorder (paranoia). Out of 4234 patients who attended psychiatry outpatient department during the year 1994-1997, 45 patients received the ICD-10 diagnosis of persistent delusional disorder. Charts of these patients were used for the study. The prevalence of delusional disorder and delusional parasitosis were around 1% and 0.5% respectively making delusional parasitosis the most common sub-type in our setting. Patients with delusional parasitosis had significantly lesser education compared to the patients with persecutory or jealous delusions. These observations are explained on the basis of cultural practices and linguistic competence.

Community based de-addiction is the need of today, but in India it is done inside the hospitals. Camp detoxification is one of the alternative approaches. The process of camp detoxification was divided into two phases. In phase I, arrangement for admission of 22 patients of drug and alcohol abuse was made, In phase II, 20 patients were admitted & were given treatment which consisted of pharmacological, psychoeducative groups & recreational & religious activities. All the patients completed 10 days treatment among them 18 patients were symptom free while 2 patients were having significant withdrawal symptom. The results of 10 days camp treatment showed better retention rate, good outcome & no use of illicit drugs during camp treatment.

Substance abuse is an important medico-social problem. Comprehensive management of substance use disorders is of necessity linked to the study of epidemiology. In India we have a reasonable epidemiological data on substance abuse. However, this data base suffers from a number of methodological lacunae. The present paper discusses these lacunae and makes appropriate recommendations for future generation of epidemiological data on substance abuse in India.

This study reviews the available Indian literature on buprenorphine abuse. Buprenorphine was introduced in 1986; the abuse, first noticed in 1987, increased rapidly till 1994, and then decreased gradually. Initiated through other addicts and medical practitioners, the abuse was mostly as a cheap, easily and legally available substitute for opioids. The typical young adult male abuser used an intravenous cocktail with diazepam, pheneramine or promethazine for a better kick. The withdrawal syndrome was typical of the opioids and without an expected delayed onset. Complications of pseudoaneurysm and recurrent koro in repeated withdrawal were reported. Buprenorphine as a detoxifying agent for opioids reportedly gave better symptom control in the first week but high rates of dependence induction were reported. The Indian data tends to caution against the Western enthusiasm to use buprenorphine for detoxification or maintenance of opioid abusers.

Here is reported an unusual case of substance dependence with buprenorphine, mephentermine, & promethazine. This combination taken through intramuscular route produced a relatively mild & delayed abstinence syndrome with features viz. increased sleep and appetite in the patients. The neurophysiological basis for use of this rare form of additive (mephentermine) with buprenorphine is speculated.

This case report describes the improvement obtained by using tranylcypromine in a patient of severe treatment resistant depression. The adverse effects faced and steps taken to overcome them have also been discussed.

A case is reported of electrocardiographic QT prolongation that was presumbty familial in origin. Torsades de points developed in association with the use ofdothinepin, despite the pmscription of a low dose of this drug.