Background: High family loading for alcoholism, early onset of alcohol use and childhood disinhibitory behaviors, persisting into adulthood, increase the susceptibility to alcoholism. At the psychophysiology level, reduced amplitude of the P300 component of the Evoked Response Potential is associated with externalizing psychopathology in children. Children of alcoholics have reduced P300 amplitudes. Preliminary data suggests a developmental lag phenomenon in the maturation of the P300. Aims: The study compares the amplitude and topography of the P300 generated in response to a visual task, between subjects at high risk (HR) and those at low risk (LR) for alcoholism and its relation to externalizing behaviors. Results: HR subjects have lower P300 amplitudes over frontal brain areas. Differences are greater in young, tending to converge with increasing age. There is a strong association between this reduced brain activation and an excess of externalizing behaviors in HR individuals. Conclusion: A maturational lag in brain development causing central nervous system disinhibition and externalizing behaviors may underlie the susceptibility to alcoholism.

Background: Major international studies on course and outcome of schizophrenia suggest a better prognosis in the rural world and in low-income nations. Industrialization is thought to result in increased stigma for mental illness, which in turn is thought to worsen prognosis. The lack of an ethnographically derived and cross-culturally valid measure of stigma has hampered investigation. The present study deploys such a scale and examines stigmatizing attitudes towards the severely mentally ill among rural and urban community dwellers in India. Aim: To test the hypothesis that there are fewer stigmatizing attitudes towards the mentally ill amongst rural compared to urban community dwellers in India. Materials and Methods: An ethnographically derived and vignette-based stigmatization scale was administered to a general community sample comprising two rural and one urban site in India. Responses were analyzed using univariate and multivariate statistical methods. Result: Rural Indians showed significantly higher stigma scores, especially those with a manual occupation. The overall pattern of differences between rural and urban samples suggests that the former deploy a punitive model towards the severely mentally ill, while the urban group expressed a liberal view of severe mental illness. Urban Indians showed a strong link between stigma and not wishing to work with a mentally ill individual, whereas no such link existed for rural Indians. Conclusion: This is the first study, using an ethnographically derived stigmatization scale, to report increased stigma amongst a rural Indian population. Findings from this study do not fully support the industrialization hypothesis to explain better outcome of severe mental illness in low-income nations. The lack of a link between stigma and work attitudes may partly explain this phenomenon.

Background: Although electroconvulsive therapy (ECT) causes no structural brain damage, recent studies reported altered brain perfusion acutely following ECT. This is in keeping with brain edema which was noted in animal experiments following electroconvulsive shock. Aim: This study examined alteration in magnetic resonance imaging (MRI) T ₂ relaxation time, a measure of brain edema, and its relation to therapeutic efficacy, orientation and memory impairment with ECT. Materials and Methods: Fifteen drug-naive consenting patients of major depressive disorder with melancholia (DSM-IV) received ECT as first-line treatment. MRI scans were done before the first ECT and at 2 hours after the second ECT. T ₂ relaxation time was measured bilaterally in thalamus, hippocampus, medial temporal lobes and dorsolateral frontal cortex by a blind rater. Results: Depression scores and memory scores were reduced significantly both after the second and fifth ECT. There was no change in T ₂ relaxation time after second ECT. Conclusion: The finding suggests that ECT does not produce demonstrable change acutely in brain parenchyma detectable by MRI scans.

Background: Among the various treatment modalities, family intervention is the most notable current advance in the area of psychosocial treatment of alcoholism. Aim: To assess the impact of family intervention therapy as an adjuvant to pharmacotherapy in alcohol-dependent subjects in a case-control study design. Materials and Methods: Thirty patients who satisfied DSM-IV Criteria for alcohol dependence syndrome were given the right package of family intervention therapy. Thirty age-, sex- and 'marital status'-matched patients who satisfied the same diagnostic criteria were given only brief supportive psychotherapy. Both groups were assessed at base line, six months and at one year using Michigan Alcohol Screening Test, Motivation Scale, Rotter's Locus of Control, Family Intervention Pattern Scale and Presumptive Stressful Events Scale. Primary efficacy variable was cumulative abstinence duration, and secondary efficacy variables were relapse rate and time to first drink. Results: Family intervention therapy significantly reduced the severity of alcohol intake, improved the motivation to stop alcohol and changed the locus of control from external to internal in the study group. Control group experienced more severe stressful life events than the study group during the follow-up periods. Drop-out rate was comparable in both groups. Conclusion: Combining pharmacological treatment with appropriate psychosocial therapies focusing on the specific problem of the patient provides better outcome than either of these therapies given alone.

Aim: To study the clinical presentations and relationship of socio-demographic variables with conversion disorder. Methods: Forty patients admitted to the department of psychiatry, Assam Medical College and Hospital, Dibrugarh, during November 2004 to August 2005 who fulfilled the inclusion criteria of the study were evaluated for socio-demographic variables and clinical presentations on a semi-structured pro forma. Results: Conversion disorder is more common in young adults (57.5%), females (92.5%) and among students belonging to nuclear family of lower socioeconomic status. A majority of the patients had an obvious precipitating factor, of which family-related (40%) and school-related (30%) problems accounted for the major types. Motor symptoms were the predominant presentation (87.5%) with pseudo seizure being the commonest.

Dhat syndrome ("semen loss"-related psychological distress) is a culture-bound syndrome seen in the natives of Indian subcontinent, but it is prevalent in other cultures also. Its diagnosis and management issues need to be taught to postgraduates in their teaching program. This syndrome involves vague and multiple somatic and psychological complaints such as fatigue, listlessness, loss of appetite, lack of physical strength, poor concentration, forgetfulness and other vague somatic troubles. These symptoms are usually associated with an anxious and dysphoric mood state. These patients may also present with or without psychosexual dysfunction. The management of Dhat syndrome needs serious attention. The understanding of this condition by Modern Medicine fails to impress most of the patients, and the explanations and reassurances offered prove to be not of much use.

We report, we believe for the first time in India, two cases of tardive oculogyric crisis in patients of schizophrenia, paranoid subtype (DSM IV code 295.30) during olanzapine therapy. Relevant data on this rare condition is discussed.