Techniques of psychotherapy commonly used in the west may be difficult to employ in their purest form for Indian patients, especially in those who are not educated and those who are not westernized. Anecdotes from the Ramayana can be used in psychotherapy to show the similarity of the issues facing the patient with the aim of increasing insight. They are powerful examples and can be used to suggest alternate modes of coping. This article discusses anecdotes, themes and possible situations for use in psychotherapy. It also suggests steps in obtaining the necessary permission from patients prior to discussing them in psychotherapy.

Objective : Oestrogen-hypothesis in schizophrenia is a largely debated issue. Being a multifactor disorder, schizophrenia has gained importance in the field of psychiatric research, especially to dig out the tentative aetiologies (genetic, biological, environmental etc.), still under tested or not tested. The present article is an attempt only to understand the possible role of oestrogen as a 'core' biological factor at the backdrop of male-female differences (in the onset, course, treatment response, prognosis) in schizophrenia barring other factors. This is to reduce the level of 'conflict' and 'confusion' in the article. Method : Electronic data search is the mainstay of the literature bank, included in the article and only 'supportive' evidences (direct and indirect) are incorporated to understand the role of oestrogen in the brain at the backdrop of schizophrenia. Result: The study comes out with a postulation that oestrogen has got a potential effect in moderating the process of schizophrenia in the females. Conclusion : Oestrogen could be tested as the 'novel' therapeutic agent in the female schizophrenics with the necessary support from the modern Nuclear Imaging Techniques to get maximum therapeutic benefit in schizophrenia.

The increasing focus on child mental health in developing countries like India points to the importance of epidemiological data in developing training, service and research paradigms.This review attempts to synthesise and evaluate the available research on the prevalence of child and adolescent psychiatric disorders in India and highlight significant conceptual and methodological trends. It identified 55 epidemiological studies conducted between 1964 and 2002 in the community and school settings. Despite considerable progress, various methodological lacunae continue to limit the value of the epidemiological surveys. These include issues related to sampling, case definition methods, tools, multi-informant data and data analysis. The importance of a socio-culturally relevant research framework has been highlighted. The review suggests directions for future research to guide planning of services that meet the mental health needs of vulnerable children and adolescents

The relation between site of stroke and cognitive deficits, anxiety, depression, and quality of life was done in 40 stroke patients using Blessed Mental Status Test, Hospital Anxiety and Depression Scale, Manchester short assessment of quality of life scale. Lesion localization was done by CT scan. In a relatively short period after stroke, specificity for any hemisphere or arterial territory of any side (left or right) was not evident for anxiety, depression, cognitive deficits or level of QOL. Considering the arterial territories involved, MCA infarcts were associated with greater cognitive deficits, anxiety and poor QOL. ACA infarcts had least anxiety. PCA infarcts were associated with better QOL and least cognitive deficits.

Aim : This study was undertaken with the objective of assessing the effect of Cognitive Behaviour therapy (CBT) on subjects suffering from schizophrenia or schizo affective disorder and to observe the sustainability of its effects over a longest period of time. A brief study was also undertaken about changes in career attitudes after psycho education about their wards' illness. Method : Fifty-one subjects participated in the study and completed the required numbers of sessions of CBT. Evaluation was carried out before and immediately after CBT. Twenty-four subjects were followed -up again after nine months to perceive sustainability of CBT effects. One family member for each subject was administered an attitude questionnaire before and after psycho education about schizophrenia. Results : CBT sessions resulted in marked improvement in overall adjustment. Intensity of symptoms decreased from high to moderate or high to low intensity immediately after CBT. At follow-up nine months later, intensity of symptoms increased from low to moderate in most of the subjects in comparison to immediate post CBT evaluation but was still less than baseline There was marked decrease in negative thoughts and feelings immediately after CBT. During follow-up after nine months 60% subjects showed more improvement marked in negative thoughts than immediate post CBT while 40% showed less improvement than immediately after CBT. Neptive feelings increased after nine months in most of the subjects, but not to pre treatment levels. Family membets also expetienced more positive feelings about their sick wards after psycho education. Conclusion : Positive effects of CBT may not be sustained over a longer period of time and may need repeated sessions

Sixty Indian muslim women outpatients with multiple somatic complaints of nonorganic origin were assessed for alexithymia and abnormal illness behavior using the Toronto Alexithymia Scale (TAS) and the Illness Behaviour Assessment Schedule (IBAS). Alexithymia represented by TAS scores correlated best with the IBAS variables of communication of affect, somatic illness causal beliefs and denial. Correlation with other IBAS variables was modest to poor.There was no correlation of IBAS variables with age of patient, duration of illness or nature of diagnosis: somatoform disorder or anxiety and depressive disorders, The study showed that alexithymia and illness behaviour are overlapping constructs and confirmed the usefulness of TAS as an instrument to discriminate between patients with anxiety/ depressive disorders and somatoform disorders

Objective : The purpose of this study was to investigate the efficacy and safety of Fixed Dose Combination (FDC) of olanzapine 5 mg and fluoxetine 20 mg in Indian patients with severe or treatment resistant depression. Design : This was an open, non-comparative study of seven weeks duration with an initial placebo run in period of one week. Method : One hundred and fifty three patients were enrolled. One hundred and forty-four patients completed the study as per protocol and 151 patients were safety evaluable. One hundred and eleven patients (77%) received one tablet of FDC of olanzapine 5 mg / fluoxetine 20 mg once daily for 6 weeks, in patients (14%), the dose was stepped up at the end of 2 weeks to 2 tablets of FDC of olanzapine 5 mg/ fluoxetine 20 mg once daily for a further 4 weeks and 13 patients (9%) required dose to be stepped up at the end of 4 weeks to 3 tablets of FDC of olanzapine 5 mg and fluoxetine 20 mg once daily for last 2 weeks. Results : One hundred and thirty four patients (93%) responded to FDC of olanzapine and fluoxetine therapy (a responder was defined as a patient with 50 % reduction over baseline in HDRS total score at the end of therapy). Statistically significant (p< 0.0001) reductions in HDRS total score, MADRS total score and CGI severity scores were seen with olanzapine/ fluoxetine combination. One hundred and four patients (72%) were remitters (HDRS total score of <7) after 6 weeks of therapy. Adverse experiences were reported by thirty one patients (20.5%). Majority of them were mild in intensity. No serious adverse event was recorded with study therapy. Three patients were withdrawn from the therapy due to adverse event. Conclusion : Treatment with FDC of olanzapine 5 mg / fluoxetine 20 mg was highly effective and well tolerated in Indian patients with severe or treatment resistant depression.

In India, the fidelity of electro convulsive therapy (ECT) devices is not regulated by any statutory body; as a result, it is conceivable that marketed devices may not meet the highest standards of quality. We therefore subjected 4 ECT devices, obtained from 4 different manufacturers, to quality testing in a biomedical engineering laboratory. The newest device was one month old, and the oldest device was 13 years old. Two devices were in regular use, and two were standby instruments, We found that not a single device was working in accordance with the manufacturer's specifications. One device was not working at all; one was delivering varying intensity, uninterrupted current rather than constant current brief pulses (whatever the settings applied); one was delivering blocks of pulses the description of which was enormously at variance with the instrument settings; and one device, the best of the four, was delivering brief-pulses with small errors in each setting that cumulated to an error of 49.3% at a common charge setting for clinical ECT. We conclude that clinicians must test the fidelity of their ECT devices at the time of purchase as well as at frequent intervals thereafter. Finally, the fidelity of ECT devices should be regulated by an appropriate statutory body in India

Alcoholic hallucinosis is a pathological mental state characterized by an acute onset of predominant auditory hallucinations that occur either during or after a period of heavy alcohol consumption. In this study, 52 patients with a diagnosis of Psychotic disorder predominantly hallucinatory associated with alcohol use (F 10.52) were evaluated after a period of three years. Past history of withdrawal hallucinations was associated with alcoholic hallucinosis The study has found a wide spectrum of outcome confirming the earlier observations that alcoholic hallucinosis is a heterogeneous disorder.

The diagnosis of comorbid psychiatric conditions have important clinical ramifications as the outcome is poorer with multiple disorders. Various studies have shown that alcohol abuse has severe adverse effects on the course of metal illness and vice versa. Only a little data on the subject are available from our country. We interviewed 30 patients suffering from alcohol dependence using SCID - I & SCID - II. Seventy six percent of the sample had axis - I comorbid diagnosis and 40% had an axis -II diagnoses. Depressive disorder and cluster B personality disorders were the most common comorbid diagnosis.

Four cases of acute manic episode (bipolar-l disorder), not responding to oral valproate or other mood stabilizer and neuroleptics were given injection valproate intravenously. Three out of 4 patients showed good response and tolerance to intravenous valporate.

Wilson's disease is a rare metabolic disorder involving copper metabolism may present with hepatic, neurological and psychiatric manifestations. We present a case of Wilson's disease with behavioral symptoms, which responded to risperidone.

Ganser syndrome continues to be a rare and widely misunderstood condition. While DSM-IV classifies Ganser syndrome as a dissociative disorder, its etiology continues to be debated. There are episodic reports in the literature of Ganser syndrome in patients with head trauma or strokes. However, the mechanisms by which these cerebral insults lead to Ganser syndrome or other dissociative states are largely unknown.A case of a patient with Ganser syndrome with a prior history of stroke and bifrontal infarcts is described. This case demonstrates how organic pathology may predispose a patient to dissociative states, such as Ganser syndrome. We review the relationship between hyperglutamatergic states, caused by stroke and stress, and dissociative symptoms.Ganser syndrome continues to be a rare and widely misunderstood condition. While DSM-IV classifies Ganser syndrome as a dissociative disorder, its etiology continues to be debated. There are episodic reports in the literature of Ganser syndrome in patients with head trauma or strokes. However, the mechanisms by which these cerebral insults lead to Ganser syndrome or other dissociative states are largely unknown.A case of a patient with Ganser syndrome with a prior history of stroke and bifrontal infarcts is described. This case demonstrates how organic pathology may predispose a patient to dissociative states, such as Ganser syndrome. We review the relationship between hyperglutamatergic states, caused by stroke and stress, and dissociative symptoms.

The psychiatric manifestrations are 77% in patients with degenerative cerebellar diseases. The most common diagnoses are depressive disorders, personality changes and cognitive impairment. Here we report a case of major depressive disorder in a patient with spinocerebellar ataxia with writer's cramp.