The deschptions, etio-pathology and some aspects of treatment of the seizure disorders in the three Indian Systems of Medicine, namely The Siddha, The Ayurveda and The Unani are briefly mentioned. If more or less, three humors cause disease, The learned count the wind is the first of these.' Medicine, Thirukkural

Often ethical concerns are limited to issues like informed consent, confidentiality patients rights etc. However ethical concern includes all areas of doctor-patient relationship? This paper will highlight ethical issues m everyday clinical practice. Clear-cut guidelines are not available in these areas but the purpose is to sensitise the profession of the need to carefully scrutinise very action of the psychiatrist during z'nical work.

The aim of the study was to detect brain oedema with electroconvulsive therapy (ECT). Magnetic resonance imaging (MRI) T2 relaxation time which is an indicator of brain water was measured one day prior to the first ECT and at two hours after second ECT in five depressive patients prescribed right unilateral (RUL) ECT. MRI 7, relaxation time was measured in hippocampus (He) and thalamus (Th) bilaterally No significant change in T2 relaxation time following ECT occurred in any of the four regions. EC T did not produce any detectable brain oedema and hence the treatment may be considered safe. The study needs to be replicated in a larger sample and also in bilateral (BL) ECT patient group.

A single day census found that long-stay patients (LSP) numbering 7,307 accounted for about 48% of the total inpatient strength of 15,345 in government mental hospitals in India. A load of 2695 (37%) LSP were in two to five years duration of stay, 2782 (38%) were in five to fifteen years duration of stay, and the remaining 1830 (25%) were staying for more than fifteen years. About 11% of LSP were aged sixty years and above, majority (53%) were males, non-voluntary cases constituted 80%. and more than two-thirds (69%) were schizophrenics. The characteristics distributions associated with high rates of LSP at individual hospitals were identified. The load of LSP was decreased by 9% during the period from 1993 to 1999.

Forty four schizophrenic patients were randomly assigned to receive risperidone in 4-8 mg doses either once daily or twice daily for 8 weeks. An open trial was conducted to determine the efficacy of once daily administration of risperidone as compared to twice daily administration. Assessment were done on Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression (CGI) scale Eighty two percent of the once daily patients and 79% of the twice daily patients showed a significant treatment response. No significant differences were observed between the two groups in response pattern and adverse effects at the end point. Risperidone given once daily was as effective as twice daily administration.

Raven's Standard Progressive Matrices (SPM) has been suggested to assist in the detection of malingering, and a putatively validated formula method for defining genuine and fake performances is available In the present study, 47 normal individuals were asked to fake cognitive impairment on the SPM; a day later, their genuine performances were obtained. As expected, the genuine performances were significantly superior to the faked performances: however, the formula method failed to distinguish between the two. The present study used logistic regression analysis to model genuine and faked performances; the method resulted in a 74.5% accurate classification. It is concluded that, while the SPM may be useful in certain cases, it cannot reliably detect malingering.

The Neuroleptic Malignant Syndrome (NMS) can have a complicated recovery and rechallenging these patients is fraught with risks of recurrence. We examined our data from a sequential case series of NMS over a four-year period for details about treatment, complications and rechallenge. Duration of NMS when treated with one versus two dopamine agonists, and neuroleptic loading rates before NMS and on rechallenge were compared using the chi-square test with correction. Duration of NMS was found to be longer when treated with more than one agonist. The mean loading rate on rechallenge. attempted in six patients, was not found tc be statistically different from that resulting in NMS However, two patients (33%) re-challenged with high-potency neuroleptics at high loading rates experienced partial recurrence. Our findings show no advantage for treating NMS with multiple agents and emphasize the need for a cautious dosing strategy while re-challenging patients with typical neuroleptics.

The phenomenology of mania has not been empirically studied adequately. Various studies have revealed 2, 4 & 5 factors as the core features defining the manic state. Differences in the Bipolar disorders have been reported across culture in the past further complicating the issue. This study was carried out to study the core features of the manic state and compare it with similar studies across culture. Hundred consecutive patients attending the Central Institute of Psychiatry's Out Patient Services for the first time with a diagnosis of manic episode or bipolar disorder, current episode mania as per Diagnostic Criteria for Research were taken up for the study. Factor analysis using Principal Components with Varimax rotation was carried out. Factor score were tested for normal distribution using Kolmogorov Smirnov statistic. The findings revealed three factors representing psychomotor acceleration, thought disorder and mood All distributions were normal. Mood was found to be on a continuum with euphoria and initability on the opposite poles.

Lithium is the treatment for acute mania and bipolar disorders. Ever since its introduction in the psychiatric arsenal, case reports of toxicity have been appearing in the literature at regular intervals. This study was thus carried out to study the presentation and associated features of lithium toxicity. In this retrospective study, case record files of all patients suspected to have developed lithium toxicity during a five year period were retrieved. It was found that toxicity presented most commonly with cerebellar symptoms and appeared at lower serum levels. Lithium could be restarted albeit at a lower dose and with a gradual titration in a number of cases.

This paper highlights the characteristics of 800 alcohol-dependent patients treated at a drug de-addiction centre, over a period of 5 years. The mean score on SADD (severity of alcohol dependence data) questionnaire was 23.95, which indicates a severe level of dependence. Followup analysis of 607 cases showed that 379 (62.4%) patients had not utilised the follow-up services beyond one month. Discussion focuses on retaining patients in follow-up.

Significant but subtle abnormalities in the thyroid functions in depressive patients, have been reported. Basal thyroid functions of 33 drug naive depressive patients having first episode of illness were compared with 31 healthy matched controls. The mean value of total thyroxin (TJ was significantly higher in depressives. Total triiodothyronine (TJ was lower in depressive patients but the difference was not significant. The mean value of thyroid stimulating hormone (TSH) was comparable in the two groups No significant difference was found with respect to total T^ and total T3 when depressive patients with various subtypes of depression were compared. But depressive patients with psychotic features had significantly higher mean value of TSH as compared to those without them. The findings are discussed in relation to the available literature.

Presentations of Anorexia Nervosa in India are usually atypical and anorexia is more commonly a symptom rather than a syndrome. This report highlights a case of anorexia following medical termination of pregnancy and laproscopic sterilisation, its association with conflicts regarding childbirth and motherhood in a 34 year old woman and the impact of anorexia on child rearing.

Culture bound syndromes are generally limited to specific societies or cultural areas and are localized. Authors report a case which seems to be a new culture bound syndrome, has atypical presentation and difficult to categories but could be diagnosed as somatoform NOS (F-45.9). This syndrome is commonly called Gilahari (Lizard) among local public and considered to be very serious and fatal illness prevalent in areas of west Rajasthan. According to public a small swelling climbs from the back reaches to neck leading to obstruction of airways and followed by death, though after examination and investigation patient did not revealed any physical illness so is seems to be a new culture bound syndrome.

Leukodystrophies are rare dysmyelinating disorders of the nervous system, which occasionally have an initial psychiatric presentation. This report describes a case of a 9-year-old boy whose initial presentation resembled a bipolar disorder but subsequent work-up revealed an underlying leukodystrophy, most likely Alexander's disease. The course of this rare disease along with the implications of making a diagnosis of leukodystrophy in a psychiatric setting is discussed.

A case of paraphilia presenting with multiple sexual deviations is reported. The disorder occurred against a background of disordered childhood and was later associated with alcohol abuse.

Risperidone is an atypical antipsychotic with broad spectrum of antipsychotic activity and lower potential for extrapyramidal side effects at therapeutic doses. This case report illustrates the development of tardive dyskinesia with therapeutic dose of risperidone in a paranoid schizophrenic patient who was not on any antipsychotic medication previously.

Rett's syndrome is a rare condition affecting only the girl child. It presents as a pervasive developmental disorder with a remarkable behavioural phenotype. The cause for this remains unknown but genetic factors and brain dysfunction have been implicated. This case report emphasises the importance of being aware of rare yet significant disorders of interest to neuro-developmental psychiatrists.

Two case reports of adverse reactions to Zolpidem are described. In both cases, the reaction was to a dosage oflOmg occurring about 15 minutes after intake of the drug.

An adult male with severe tic disorder presented with recurrent injury to tongue and dysphagia. There were a significant excess of acanthocytes in the peripheral blood smear. Treatment with lithium resulted in a considerable reduction in the severity of tics and self-injurious behaviour.