Suicide is an important mode of death. There are many psychiatrically ill patients in therapy running different degree of suicide risk. The risk of death by suicide is with almost all psychiatric illnesses, but it is found more with depressive disease, schizophrenia and personality disorder. Many studies have reported higher incidences of suicide attempts and suicide among alcoholics, which is often precipitated by family crises. Drug problems, low threshold for tolerance of day to day frustration, unemployement and poor parenting are major causes for youth suicide. There is biological evidence of suicidal behaviour. Fall in the level of serotonin and 5-HIAA in the CSF and in hind brain is found in subjects dying from suicide. Researchers have found decreased melatonin level in depression and suicide attempters. Long term therapy with antidepressants (Tricyclics), mood stabilizers (lithium and valproate) and new SSRIs prevent relapses and lessen suicide. It was concluded that general hospital doctors are in position of reducing suicide rates. Education of physician in detection of depression and suicide prevention will result in decline in number of suicides. The important measures include limiting the ability of methods of self-harm, antidepressants, paracetamol and insecticides.

Substance abuse is a heterogenous disorder that necessitates classification for purposes of evaluation and treatment. Although a large number of typologies have been generated, the research has mostly focussed on alcoholism. The typologies of 'age at onset' and Cloninger's Type 1/Type2' have been extensively researched even though there is a lack of adequate validation. The present review of various typologies focusses more on the conceptual and methodological issues. A critique of the typological work is presented; highlighting the paucity of Indian research in this important area of substance abuse.

Practical difficulties associated with assessment of central parameters necessitates the development of peripheral markers of suicidal risk. Recent research suggest that serum lipid profile may be a useful indicator of suicidal behaviour. Serum lipid profiles of forty suicide attempters were compared with forty age, sex and BMI matched controls. Total serum cholesterol, serum Triglyceride, LDL levels and HDL levels were found to be lower in suicide attempters but were not statistically significant. Statistically significant negative con-elation was seen between risk-rescue score and above mentioned parameters. No statitically significant difference was observed when various diagnostic break-up groups of patients were compared.

A study of the complex relationships between the patient characteristics, family and environmental influences, physician's behaviour and the demands of the disease with its management in Juvenile Diabetics was taken up at a general hospital. 90 subjects were selected for the study and grouped into three. Group A consisted of 30 Juvenile Diabetics, Group B of 30 Adult Diabetics and Group C of 30 Normal healthy adolescents. The impact of the illness was measured on the Diabetes Impact Measurement Scale (DIMS), the behavioural deviations and the parental attitudes towards child rearing on the Fallstrom's Questionnaire (FQ) and the family environment on the Family Climate Scale (FCS). Psychiatric morbidity was assessed using DSM-IV criteria. Group A & B were compared on the DIMS and Group A &C on FQ & FCS. Adult diabetics had a greater impact of diabetes. Juvenile diabetics had significantly higher frequency of behavioural deviations as compared to controls. Also there was a higher number of responses on questions indicating an overprotecting attitude amongst parents of juvenile diabetics. There was an increased incidence of psychiatric morbidity in juvenile diabetics as compared to normal adolescents irrespective of the family environment. The results are discussed in relation to current literature.

Chest pain is one of the most common symptoms in psychiatric and primary care practice and a frequent reason for extensive diagnostic work-up. Despite extensive investigations no recognizable medical cause to account for these symptoms is detected in many patients with chest pain. Studies of patients with non-cardiac chest pain have revealed that many continue to report symptoms and disability despite medical reassurances. The aims of the study were to evaluate the prevalence of psychiatric morbidity, personality profile and stressors along with functional impairment in patients with chest pain and normal angiographic findings and compare the same with patients who have chest pain but abnormal angiographic findings and a diagnosis of ischemic heart disease. The study included 30 consecutive patients in each group. The scales used were SCID-I of DSM-III-R, 16-PF, semi structured questionnaire for assessment of type A behaviour, PSLES and GAF scale of DSM-III-R. Panic disorder and depression were highly prevalent in patients with atypical chest pain. These patients had lower prevalence of type A behaviour, a unique 16-PF profile, experienced more stresses at any given point in time and significant impairment in day-day and in socio-occupational functioning.

Recent reports have indicated an increasing prevalence of HIV infection in the mentally ill. Reports have also emphasised the etiological role of HIV infection in psychiatric illness. The aim of this study was to assess the clinical and risk profile of psychiatric inpatients found seropositive for HIV infection. All psychiatric inpatients from a psychiatric hospital who tested positive for HI V infection over a five year period were assessed. The assessments included a detailed clinical history, psychiatric assessment and risk behaviour evaluation. Of the 2283 psychiatric patients tested, 51 were found to be seropositive. 43 patients were included in the study. 30 (69.7%) had a diagnosis of alcohol dependence, of which, 11 patients had comorbid psychiatnc diagnosis in the form of affective disorders (23%) and psychosis (14%). Personality disorders were seen in 9 patients. In 19% the clinical manifestation was considered to be etiologically related to HIV infection. The predominant risk behaviour was in the form of multiple partner heterosexual contacts. In several patients the risk behaviour had occurred during an episode of mental illness or under the influence of alcohol. The study demonstrates the importance of detecting and describing HIV infection and its manifestation among psychiatric patients.

A double blind study was undertaken to compare the efficacy between centbutindole and haloperidol. A total of 44 patients suffering from schizophrenia diagnosed in accordance to ICD-10 criteria were included. They were randomly assigned into two groups receiving centbutindole (4.5 mg) or haloperidol (15 mg) in two divided doses per day for six weeks. Each patient was evaluated on Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Scale (CGI-S) and UKU side effect scale every week. Five patients (1 patient in centbutindole group, 4 patients in haloperidol group) dropped out due to various reasons. A total of 39 patients (21 patients in centbutindole group and 18 patients in haloperidol group) completed the study. The results revealed an early onset of therapeutic effect with centbutindole for both positive and negative symptoms. However, the efficacy was comparable between centibutindole and haloperidol from 3rd week onwards.

Seventy six, first episode, drug naive patients of schizoaffective disorder, diagnosed as per DSM-III-R criteria, were followed up over a period of two years in order to verify the consistency of diagnosis. It was observed that only in 14 (18.4%) patients diagnosis did not change over a period of two years. In the majority of the patients (47, 61.9%) the diagnosis changed to schizophrenia. Eight patients (10.5%) had only depressive symptoms during the subsequent episodes and they satisfied the diagnostic criteria for major depression. While 7 (9.2%) patients remained symptom free over the study period and so diagnosis of schizoaffecive disorder could not bejeconfirmed. The paper cautions against the diagnosis of schizoaffective disorder early in course of illness.

Patients of late onset schizophrenia (LOS) (13 subjects), early onset schizophrenia (EOS) current age above 40 years (15 subjects) and early onset schizophrenia (EOS)- current age at or below 40 years (15 subjects) were compared. The LOS group differed from the two EOS groups only in having higher score on the item 'persecutory delusions'. The findings do not support the diagnostic validity of LOS.

This open study was undertaken to assess the efficacy of clozapine in resistant schizophrenics, its side effects and safety profile and the mean dose required. Sample consisted of 28 patients who had been previously treated with neuroleptics and ECTs. A special proforma was prepared for recording the psychopathology and side effect profile. The complete blood count, differential count and BPRS scores were recorded weekly for a period of 3 months. Within 1 month of treatment on a dose range of 100-200 mg/day a 25%-50% decline in the BPRS score was noticed, the mean dose required was 241 mg/day. Sedation and sialorrhoea constituted the commonest side effects in 90% patients. No case of agranulocytosis was reported. The implications of the study are discussed.

Stress and coping in the families caring for their member with mental retardation has recently received worldwide research attention. There is no comprehensive instrument to study these issues in India. This study reports on development and standardization of a new instrument to fill this lacuna. Family Interview for Stress and Coping in Mental Retardation (FISC - MR), a semi-structured interview schedule, was developed as a part of two years prospective study of efficacy of brief family intervention for 157 children with mental retardation (funded by ICMR). The tool consists of 2 sections - one measuring stress (daily care, emotional, social and financial) and the other measuring mediators of stress or coping strategies (awareness, attitudes, expectations, rearing practices and social support). Results indicate moderate to high reliability (internal consistency, inter-rater reliability and test-retest reliability) and validity (factorial, criterion and construct) of the instrument. It is concluded that FISC -MR is a useful, reliable and valid instrument for both clinical and research purposes.

To study the reliability and applicability of the Composite International Diagnostic Interview (CIDI) in a rural community of India, a two steps sampling procedure was adopted, Step I: A clinical diagnosis based on the Diagnostic and Statistical Manual of Mental Disorder-Ill-Revised (DSM-IIIR) criteria was administered to 218 persons aged 18-60 years who consulted the Primary Health Centre (PHC); Step II: Of these persons, 71 were selected for detailed examination with the CIDI Hindi version in their home environment. The current diagnoses produced by the CIDI (scored two ways DSM-III-R and ICD-10) were evaluated against the DSM-III-R clinical diagnoses. The kappa values were 0.43 and 0.64. The likelihood ratios of positive CIDI-DSM-III-R and CIDI-ICD-10 were found to be 13.11 and 17.23; the specificity rates were 95.4% in each; the positive predictive values were 96.6% and 97.4% and the sensitivity rates were 59.2% and 77.5%. A significant longer time was faken for coding one CIDI. Only 8% of the 71 CIDI interviewed required more than one sitting. 96% of those interviewed were receptive for future interviews with CIDI. The study findings emphasize the good reliability and acceptability of the CIDI in a rural community of India.

Even though cultural, biological and health service factors influence the tolerance and acceptability of psychotropic drugs in different settings, there is a lack of data on the use of antidepressants in primary care settings from India. The aim of this study was to examine the tolerance of 3 models of antidepressants treatments (fluoxetine 20 mg; imipramine 75 mg; imipramine 150 mg) for common mental disorders in attenders at a primary care clinic in Goa. The study design was a randomized trial. A total of€1 adult subjects with a common mental disorder were recruited and randomized to one of the 3 groups. Subjects were reviewed at 2 and 6 weeks. The main outcome measures were discontinuation rates. The key findings are that while discontinuation rates are higher in subjects on imipramine 150 mg as compared to the other groups, the majority of subjects in all groups discontinued their medication. The commonest reasons for discontinuation are anticholingeric and hypotensive side effects.

This study was aimed to screen the patients for phenylketonuria among chronic psychiatric inpatients. A total of 577 cases were studied which included mentally retarded patients, schizophrenics and those suffering from depressive disorders. During the extensive screening not a single positive case could be identified. The findings of this screening support the previous studies. Looking at low incidence of PKU we do not recommend extensive screening for PKU.

A young male with bipolar affective disorder, mania with psychotic features was started on lithium therapy. Four days later, he developed an irregular pulse on a lithium level of 0.45 mmol/L. An ECG showed multiple unifocal ventricular ectopics. The cardiac arrhythmia disappeared when lithium was discountinued.

Dementia is not an uncommon presentation in psychiatric practice. Of the various causes of reversible dementia, subdural hygroma is a lesser-known potentially reversible cause. A case of dementia with Kluver-Bucy symptoms secondary to subdural hygroma is described and implications of Kluver-Bucy symptoms in dementia are discussed.

A 12-year-old girl presented with complaint of passing very 'scanty' amount of urine, approximately 50 ml every alternate day for the last five years. She had been admitted for investigations several times in different hospitals in the past. On evaluation, she was found to have no abnormality related to the urinary tract. Detailed psychiatric assessment revealed the factitious nature of her symptoms, suggesting the diagnosis of factitious disorder with physical symptoms.

Primary hypersomnia, a rare clinical syndrome, was diagnosed in a 14-year-old boy. The syndrome showed partial response to high dose fluoxetine therapy (120 mg/day) which recruited insomnia, an adverse effect of the drug, for therapeutic purposes. Response was enhanced with intermittent methylphenidate in association with a lower dose of fluoxetine. A possible pharmacokinetic interaction developed, comprising fluoxetine-induced augmentation of methylphenidate activity; such an interaction has not been previously reported.