Background: Studies comparing the stress perceived by parents of mentally retarded and normal children are limited. Aim: (i) To find whether there exists a difference in the perceived stress between both the parents of mentally retarded children, (ii) to study whether these stresses occur more frequently in parents of mentally retarded children compared with those of normal children, and (iii) to find any correlation between the severity of perceived stressors and the anxiety state of these parents. Methods: This study was conducted in the Child Guidance Clinic of a tertiary care psychiatry hospital. The study sample, comprising 180 subjects, was categorized as: group A (60 parents of profound to moderately mentally retarded children), group B (60 parents of mild to borderline mentally retarded children) and group C (60 parents of children with normal intelligence), which served as the control group. Each parent was evaluated using the Family Interview for Stress and Coping (FISC) in Mental Retardation, and the Hamilton Anxiety Rating Scale (HARS). Results: Parents in group A had a significantly higher frequency of stressors and level of anxiety as compared to those in groups B and C. A positive correlation was found between the level of anxiety and stressors. Conclusion: Multifaceted factors made parents in groups A and B more vulnerable to stress compared with parents in the control group.

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Background: There is a dearth of studies assessing the burden of caregivers of patients with schizophrenia and illness-related variables such as age, sex, duration of illness, domicile, martial status, education, employment and previous hospitalization. Aim: The study was conducted to measure the perception of burden by caregivers of patients with schizophrenia and its correlation with nine factors on the Burden Assessment Schedule (BAS) related to spouse, physical and mental health, external support, caregiver's routines, support to patient, responsibility-taking, other relatives, patient's behaviour and caregiver's strategy. Methods: Using BAS, we assessed the burden in a sample of caregivers of 34 patients with schizophrenia taken from the OPD of the Institute of Mental Health and Hospital, Agra. Results: A low positive correlation was found between urban domicile and support of the patient; of domicile Agra and effect on other relations; and domicile Agra and effect on the caregiver's routine. There was a low positive correlation between age less than 30 years and the physical and mental health of the caregiver, and with taking responsibility. The t test for population correlation was significant up to 5% probability level (p<0.05) for correlation between urban domicile and support of the patient; between domicile Agra and effect on other relations; between domicile Agra and the effect on the caregiver's routine; between age less than 30 years and the physical and mental health of the caregiver; and between age less than 30 years and taking responsibility. Conclusion: Further studies in this field are required including one with a non-linear correlation analytic design.

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Folie a deux is defined as an identical or similar mental disorder affecting two or more individuals, usually the members of a close family. Two case reports of this condition are presented with a brief review of the literature. Prompt recognition of this condition is an essential step in the management. The majority of patients with folie a deux require multiple treatments including separation, antipsychotics, individual and group psychotherapy, and family therapy.

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Factitious disorder is a challenging phenomenon in clinical practice. An inconsistent clinical picture and the presence of symptoms that do not respond to the seemingly appropriate treatment should alert the clinician about the possibility of such a diagnosis. A case of factitious psychological symptoms suggestive of schizophrenia is reported, and the issues of diagnosis and management are discussed in the light of the available literature.

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Background: Support groups for families of persons with mental illness are emerging as significant components in psychosocial rehabilitation programmes. Aim: To ascertain the expectations of family members who attend family support group meetings and to find out the efficacy of such programmes. Methods: The data were collected from support group members using a semi-structured interview schedule. The study sample (n=20) was drawn from family members who attended the support group meetings regularly for a minimum period of 6 months. Data analysis was done using percentile. Results: Analysis of the data revealed that members attending the support group meetings expected to get more information about the illness, develop skills to cope with problems at home and learn skills to deal with the ill person. An important finding of the study was that the members developed a 'feeling of togetherness' as a result of being a member of a group with common aims. Conclusion: Participation in a support group meeting positively affects key variables in the participant's adaptation to mental illness in a relative.

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Background: Deficits in neurocognitive function are a hallmark of schizophrenia. They are associated with clinical manifestations and the course of the illness. A study of cognitive dysfunction in Indian patients with schizophrenia is of significance in view of a more benign course and outcome of the illness in this region. Aim: To study cognitive deficits and associated factors in patients with chronic schizophrenia and compare them with those in the normal population. Methods: We compared 100 patients with chronic schizophrenia with 100 matched normal controls on multiple measures of attention, executive function and memory. Results: Compared to normal individuals, patients with schizophrenia performed poorly in all cognitive tests. Cognitive deficits in patients were related to gender, education, age, duration of illness, and presence of positive and negative symptoms. Conclusion: The neurocognitive profile of Indian patients with chronic schizophrenia resembles those of patients in developed countries.

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Background: In India, there is a paucity of trained professionals to execute psychosocial interventions. Families are thus assigned the role of primary caretakers of individuals with chronic mental illness. Aim: To assess the perceived benefits and difficulties of group meetings among caregivers of persons with schizophrenia and bipolar mood disorders, and to evaluate the utilization pattern of general hospital psychiatric unit (GHPU) services by caregivers who regularly attend such group meetings. Methods: Persons with schizophrenia and those with bipolar mood disorders with associated psychosocial problems and on maintenance medication were identified at the Psychiatric Rehabilitation Unit of the Department of Psychiatry, Father Muller Medical College. Significant caregivers of the identified patients were informed about the group meeting. Group meetings were conducted for about 45 minutes once a month for caregivers of patients with schizophrenia and bipolar mood disorders. Data regarding the psychosocial aspects of caregivers were collected before entry to the meeting and after 17 months of their participation. Participants who attended the meetings irregularly were excluded from the study. Results: The group meetings led to effective monitoring of the functioning of individuals, a reduction in the subjective family burden and family distress, a better support system with adequate coping skills and good compliance with treatment programmes. Conclusion: Conducting regular group meetings for a homogeneous population at a GHPU is feasible and beneficial.

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Paroxetine is a commonly used antidepressant with a safe side-effect profile. A case of paroxetine overdose (560 mg) is reported in an 18-year-old female who attempted suicide and recovered without any sequelae, requiring only supportive treatment. This report highlights a case of pure paroxetine overdose and the safety profile of paroxetine in overdose.

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Background: The number of studies from India on geriatric health problems, particularly mental health disorders and quality of life, is limited. Aim: This cross-sectional study was carried out in the geriatric population visiting the Dr T.M.A. Pai Rotary Hospital, Karkala, Karnataka. It examined the different domains of quality of life according to sociodemographic variables. Methods: We studied 70 individuals in the geriatric age group (?60 years) who visited the hospital over a period of two months from March 2003 to April 2003. The results were expressed in terms of mean and SE of mean. Z-test and one-way ANOVA test were applied to compare the mean scores of different variables under the four domains. A p value <0.05 was considered significant. Results: The total mean score, as well as the mean scores in each of the four domains studied were similar in men and women as well as literates and illiterates. The mean scores of subjects in various age groups differed significantly in the domains of physical, psychological and social relations, while single and married subjects differed significantly in the domains of environmental and social relations. Overall well-being was significantly affected in those who were single (unmarried/widowed) or in the age group of 60-69 years.

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Obsessive-compulsive disorder (OCD) and epilepsy tend to share a close association. However, the exact relationship between OCD symptoms and epileptic convulsions is not well known. A case of OCD who improved remarkably following drug-induced seizures is described, implicating a role for convulsion as an alternative therapeutic modality in OCD.

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Background: Cognitive deficits-the hallmark of schizophrenic deterioration-still remain elusive as far as their pathophysiology is concerned. Various neurotransmitter systems have been implicated to explain these deficits. Abnormalities in cholinergic neurotransmission in the brain are one of the postulations; acetylcholine has also been postulated to regulate rapid eye movement (REM) sleep, especially REM latency. Thus, REM latency in patients with schizophrenia might provide a non-invasive window to look into the cholinergic functions of the brain. Aim: To study REM sleep measures and neurocognitive function in schizophrenia, and the changes occurring in these parameters following pharmacological treatment. Methods: Thirty subjects (15 with schizophrenia and 15 normal non-relative controls) were evaluated in this study. Most patients with schizophrenia had prominent negative symptoms and deficits in the performance in neurocognitive tests battery. They were treated with antipsychotics for a variable period of time and post­-treatment evaluation was done using the same battery of neurocognitive tests and polysomnography. Patients were either drug-naive or kept drug-free for at least two weeks both at baseline as well as at the post-­treatment stage. Results: A positive correlation between the severity of negative symptoms and neurocognitive deficits (especially on the Wisconsin Card Sorting), and a negative correlation between these two parameters and REM latency was observed. Conclusion: It can be hypothesized that the acetylcholine deficit model of dementia cannot be applied to schizophrenic dementia, rather a hypercholinergic state results. This state warrants anticholinergic medication as a treatment option for negative symptoms of schizophrenia.

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