MANAGEMENT OF SCHIZOPHRENIA : AN UPDATE

Introduction of potent antipsychotics for the treatment of schizophrenia not only brought changes in the outlook for management of this disorder but also infused optimism and hope. However, substantial number of patients fail to respond to conventional antipsychotics thus creating a class of patients who are termed as treatment resistant, treatment refractory or difficult to treat patients. This update focuses on such patients and provides description of various options for their management Though atypical antipsychotics offer respite to a vast number of such difficult to treat patients, their efficacy is perhaps over-emphasised. Conversely, the potential of psychosocial therapies in such patients has not been fully exploited. Management of such patients in the community is a challenge and in taking up this gauntlet, a judicious mix of pharmacotherapy and psychosocial intervention strategies, close monitoring of the patients with a view to detect prodromes of relapse and early intervention are likely to play increasingly important part

POSTGRADUATE PSYCHIATRIC TEACHING CENTRES: FINDINGS OF A SURVEY

A survey by a questionnaire method was undertaken to enquire about the facilities, the level of medical and non-medical staffing, structure and functioning of psychiatric teaching centres offering teaching and training in psychiatry at postgraduate level. The results of the survey are presented and discussed. It is evident that postgraduate teaching centres are inadequately staffed and poorly equipped. The implications of these vis-a-vis teaching and training and effective participation in the implementation of National Mental Health Programme are commented upon

SOCIAL SUPPORT, SOCIAL DYSFUNCTION AND STRESSFUL LIFE EVENTS IN NEUROTIC PATIENTS.

The relationship between social support, stressful life events and psychosocial dysfunction was studied in 197 neurotic patients comprising 65 patients of Generalized Anxiety Disorder, 81 of Dysthymia and 51 of Dissoiative (conversion) Disorders. It was seen that Dysthymics perceived themselves to have significantly less social support in comparison to Generalized Anxiety or Dissociative Disorders patients. Significant correlations between social support and life events and social support and dysfunction were also obtained and it was observed that lack of social support is negatively correlated with greater life stresses and dysfuction

SYMPTOMATOLOGY, SYMPTOM RESOLUTION AND SHORT TERM COURSE IN MANIA

In a prospective study, 40 patients satisfying DSM-III criteria for the diagnosis of a manic episode were identified and followed up for a period of 90 days. The patients were assessed on the Present State Examination Schedule and the Bech Ralaelsen Mania Scale. The severity of manic illness in the patients was observed to be same as in patients from the West. Symptoms of mania followed a variable pattern of symptom resolution. Majority of patients had recovered by the end of 90 days and were functioning normally

PATTERNS OF ANTIDEPRESSANT PRESCRIPTIONS : II CONTINUATION PHASE TREATMENTS

In an exercise carried out to ascertain adequacy of antidepressant treatment, seventy case notes of patients of depression on continuation treatment with antidepressants were scanned. Antidepressants had been used universally. TCAs were the most commonly used drugs, although Fluoxetine had also been used quite frequently. Continuation treatment was found to be deficient in over a third (n=24; 34 %) of the cases, on either of the two parameters i. e. dose of drugs or duration of treatment. The outcome was poorer in those treated inadequately. The reasons for this ‘treatment gap’ need to be explored. Similar studies need to be conducted in other settings. Education of all clinicians about these central issues of antidepressant treatment is essential

LIFE EVENTS IN OBSESSIVE COMPULSIVE NEUROSIS

Twenty four patients diagnosed to be suffering from Obsessive Compulsive Neurosis for the first time and individually matched controls were rated on a Life Events Scale. Leyton Obsessional Inventory was also administered to the patients and controls. It was seen that patients had significantly higher scores on life events for a time span of one year prior to the onset of illness as compared to controls. The patient group also scored highly on obsessional trait scores. The study points to a strong association between excess of life events and the onset of obsessional illness

A CLINICAL STUDY OF POSITIVE AND NEGATIVE SUBTYPES OF SCHIZOPHRENIA

Using a cross-sectional phenomenological approach, 40 schizophrenic patients satisfying Research Diagnostic Criteria were divided into positive, negative and mixed subtypes. On variables like age, duration of illness, and premorbid adjustment significant differences emerged between positive and negative subtypes. No significant differences were found when positive and negative subtypes were compared on variables like intelligence, memory, history of treatment with neuroleptics and electroconvulsive therapy and past and family history of schizophrenia. The results are compared with other studies

OBSESSIVE COMPULSIVE NEUROSIS IN NORTH-WEST INDIA: A phenomenological study*

Seventy two patients fulfilling Research Diagnostic Criteria for obsessional illness were studied in detail from a phenomenological point of view. Frequency of various forms and contents of obsessions and compulsions were delineated. The forms of obsessions seen were; doubts (65%); thinking (52.7 %); fear (47.2%); magical thinking (36.1%); impulse (4.1%); image (4.1 %) and others (5.5%). In compulsions, yielding compulsions were most common being present in 59.7% of the cases. Analysis of the content of the obsessions revealed that dirt and contamination was the commonest content (48.3%)