IMPULSE CONTROL DISORDERS : NOSOLOGY AND CONCEPT

Impulse control disoders have long been recognized. Although included in nosological systems since two decades, their diagnostic validity individually, as well as a category remains in question. Conceptually, these have been linked to variety of other psychiatric or medical disorder viz. OCD, affective disorders, addictive disorders, organic mental conditions etc, but systematic studies have not been done. The present review focuses on the nosological and conceptual evolution of these disorders and highlights the overlap and boundaries with other psychiatric disorders

Schizophrenia Research: Indian Scene in Last Decade

Schizophrenia is a major psychiatric disorder that not only carries significant morbidity and disability for the sufferer but also a major burden to the society in terms of cost of care. Since its recognition, big strides have been made worldwide in order to understand and treat this disorder. In a developing country such as India, research into the various aspects of this disorder is still not a priority. Despite this scenario, large number of centres across the country have been conducting research in the last four decades. During this time, scope, emphasis and quality of research seem to have undergone a lot of change. In order to examine whether such a change actually exists and the emphasis of research in last decade, a review of research published in Indian Journal of Psychiatry was undertaken. Various studies published on schizophrenia in the last decade (1990-2000) were reviewed. Important landmarks have been highlighted and limitations pointed out

Ziprasidone-induced skin reaction : A case report from Indian subcontinent.

Ziprasidone, yet another atypical antipsychotic, has been associated, in this report, with development of photo-allergic skin reaction in therapeutic dose

OLANZAPINE IN THE TREATMENT OF SCHIZOPHRENIA : AN OPEN LABEL COMPARATIVE CLINICAL TRIAL FROM NORTH INDIA

The aim of the present study was to assess the efficacy and safety of olanzapine in the treatment of schizophrenic patients. 27 patients were randomly assigned to treatment with olanzapine or haloperidol over 12 weeks. The primary efficacy measure was the mean change from baseline to endpoint in total scores on the Brief Psychiatric Rating Scale (BPRS) and assessing treatment emergent adverse events. Secondary measures were positive symptoms, negative symptoms, general psychopathology depression, anxiety and quality of life. Compared to haloperidol, olanzapine had equal effect in improving overall psychopathology, positive symptoms, and severity of schizophrenic illness. Olanzapine showed supehor improvement on negative symptoms and secondary depressive features. Commonest side effects were weight gain, sleepiness and increased duration of sleep. Olanzapine is effective in improving overall psychopathology including positive symptoms, negative and secondary depressive features in Indian patients with schizophrenia and it is safe and well tolerated at dosage between 5 to 20 mg/da

CLINICAL VARIABLES AS PREDICTORS OF RESPONSE TO ELECTROCONVULSIVE THERAPY IN ENDOGENOUS DEPRESSION

There is lack of consensus on the clinical variables that predict response to ECT. Identification of clinical variables could help in predicting the type of response before the start of ECT Therefore, a prospective study on 22 patients of severe depression, some of whom were drug-naive and others drug free at time of ECT was undertaken. A maximum of six ECT were administered with a prior definition of ‘good response’ (60% or greater reduction in Hamilton Depression Rating Scale scores) Results showed that three clinical variables could distinguish between good responders and poor responders Hence, response to ECT was associated with the duration of past depressive episodes, suicidal thoughts and somatic symptoms

FAMILIAL REVERSE SEASONAL AFFECTIVE DISORDER - A CASE REPORT

A patient with recurrent summer depression for seven consecutive years is described, whose mood significantly worsened with increased environmental temperature. She had a family history of recurrent summer depression in both her brother and paternal grandmother with symptoms similar to those of typical endogenous depression. The patient′s mood switched to hypomania with antidepressant therapy

DHAT SYNDROME IN A FEMALE- A CASE REPORT

Dhat syndrome is a commonly diagnosed disorder in Indian male patients. Patients present with various physical and mental symptoms which are attributed to the passage of “Dhat”(commonly semen) in urine. A case of an adult female is described who presented with complaints of aches and pains, headaches and poor concentration which she attributed to “wetness” experienced per vaginum during sexual intercourse. Arguments are presented for the existence of “Female Dhat Syndrome

Concept and Management of Treatment Resistant Schizophrenia (TRS)

Treatment resistance in schizophrenia is a fairly common problem faced by psychiatrists worldwide. The concept and definition of Treatment Resistant Schizophrenia (TRS) is still far from satisfactory. Data suggests the presence of biological factors underlying TRS. Second generation antipsychotics are advocated for patients with TRS. However, till date, clozapine remains the treatment of choice. Evidence for other pharmacological measures and ECT is accumulating. Psychosocial interventions do form an integral component of management of TRS. It can be concluded that, with advances in sychopharmacology, TRS needs to be better researched and managed in the future

RESPONSE TO FIRST ECT IN DEPRESSION : A PREDICTOR OF OUTCOME

Response to first ECT in depression and its value as a predictor of response to ECT is a poorly researched subject. Twenty-two antidepressant-free patients of severe depression (ICD - 10) were administered a course of 6 ECTs using bilateral sine-wave electrical stimulation with serial assessments on Hamilton Depression Rating Scale (HDRS). Using ‘a priori’ definition for ‘good response’ (≥ 60% reduction is baseline HDRS scores) patients were grouped and analysed. The reduction in HDRS scores after first ECT was significantly greater for Good Responders (GR) in comparison to ‘Poor responders’. It appeared that ≥ 9% reduction in baseline HDRS scores after the first ECT was associated with ‘Good Response’. Thus, it can be concluded that response to first ECT could be taken as a viable predictor of response in depression