Renal function in children receiving long-term lithium prophylaxis.

Four children who had received lithium carbonate for 3-5 years had unimpaired tubular and glomerular renal functions. Their serum lithium levels had been maintained at 0.5-1.0 meq/liter, and side effects had not been a problem.

Community outreach for untreated schizophrenia in rural India: a follow-up study of symptoms, disability, family burden and costs.

BACKGROUND: In resource-poor countries, there remains an alarming treatment gap for people with schizophrenia, particularly those living in rural areas. Decentralization of mental health services, including community-based outreach programmes, represents one obvious strategy for bringing appropriate care to these communities. This study set out to assess the costs and effects of such a programme in rural Karnataka in India. METHOD: Eight rural communities were visited by an outreach team, who identified cases of drug-naive or currently untreated schizophrenia. Recruited cases were provided with appropriate psychotropic medication and psychosocial support, and after obtaining informed consent were assessed every 3 months over one and a half years on symptomatology, disability, family burden, resource use and costs. A repeated-measures analysis was carried out to test for significant change in these outcome measures over this period. RESULTS: A total of 100 cases of untreated schizophrenia were recruited, of whom 28% had never received antipsychotic medication and the remaining 72% had not been on medication for the past 6 months. Summary scores for psychotic symptoms, disability and family burden were all reduced significantly, with particular improvement observed at the first follow-up assessment. Increases in treatment and community outreach costs over the follow-up period were accompanied by reductions in the costs of informal-care sector visits and family care-giving time. CONCLUSIONS: Efforts to organize community-based care such as outreach services for people with schizophrenia living in more remote areas of resource-constrained countries can bring substantial benefits to patients and families alike.

A nosological study of patients presenting with somatic complaints.

The nosological status of patients presenting with multiple somatic complaints with reference to ICD-9 was examined in the present study. In 22% of the cases it was not possible to arrive at a single ICD-9 diagnosis. The majority of these cases had combinations of somatic, anxiety and depressive symptoms. Nine percent of the cases could not be given any psychiatric diagnosis using ICD-9. These cases had very few psychological symptoms and were not identified as psychiatric cases by the present state examination. The various possible factors responsible for this diagnostic uncertainty have been highlighted.

Training primary care medical officers in mental health care: an evaluation using a multiple-choice questionnaire.

This report aimed to evaluate the mental health knowledge of primary care medical officers following short-term training in mental health care using a multiple-choice questionnaire. Seventy-eight medical officers who underwent 2 weeks' training in mental health care were assessed using parallel forms of a standardized multiple-choice questionnaire administered before and soon after the training. Young doctors scored significantly higher in the pretraining assessment. The medical officers demonstrated a significant gain in knowledge, although the amount of gain varied. Doctors who had relatively lower pretraining scores showed a higher gain. Six doctors (8%) showed less than acceptable posttraining scores. These doctors were older than the rest of the group. The doctors' pretraining knowledge was best with respect to epilepsy and poorest with respect to manic-depressive psychosis. Items pertaining to epidemiology and aetiology elicited relatively less gain than other clinical dimensions.

Saliva lithium levels for monitoring lithium prophylaxis of manic depressive psychosis.

The usefulness of salivary lithium values for monitoring long-term lithium prophylaxis was studied in 60 patients on lithium therapy. A total of 99 pairs of saliva and serum samples were obtained, and the correlation between serum and salivary lithium levels (r = 0.73) was found to be significant at the 1% level. The ratio of salivary serum levels to that of serum was found to range from 1.77 to 6.68. The ratio of 51% of the samples was between 3 and 3.99. It is therefore suggested that it is important to identify the subgroup of patients who show better correlation of salivary and serum lithium levels and use each individual's ratio to monitor only his lithium therapy.

Development of case vignettes to assess the mental health training of primary care medical officers.

This article reports the development of case vignettes as a method of assessing the short-term in-service training of primary care medical officers in mental health care. A pool of 18 case vignettes representing common psychiatric problems and a standard response sheet were written first. This was mailed to 45 psychiatrists for their comments. Based on the comments received from 21 psychiatrists, 2 sets of questionnaires with 7 vignettes in each set were developed. When administered to a group of 32 medical officers, this method of assessment was found to be sensitive in detecting gain in knowledge and skills following training. Further, performance on case vignettes was found to correlate positively with clinical skills when actual cases were given for assessment.

The mental health country profile: background, design and use of a systematic method of appraisal.

This article describes the construction and use of a systematic structured method of mental health country situation appraisal, in order to help meet the need for conceptual tools to assist planners and policy makers develop and audit policy and implementation strategies. The tool encompasses the key domains of context, needs, resources, provisions and outcomes, and provides a framework for synthesizing key qualitative and quantitative information, flagging up gaps in knowledge, and for reviewing existing policies. It serves as an enabling tool to alert and inform policy makers, professionals and other key stakeholders about important issues which need to be considered in mental health policy development. It provides detailed country specific information in a systematic format, to facilitate global sharing of experiences of mental health reform and strategies between policy makers and other stakeholders. Lastly, it is designed to be a capacity building tool for local stakeholders to enhance situation appraisal, and multisectorial policy development and implementation.

The International Consortium on Mental Health Policy and Services: objectives, design and project implementation.

The concept of the burden of disease, introduced and estimated for a broad range of diseases in the World Bank report of 1993 illustrated that mental and neurological disorders not only entail a higher burden than cancer, but are responsible, in developed and developing countries, for more than 15% of the total burden of all diseases. As a consequence, over the past decade, mental disorders have ranked increasingly highly on the international agenda for health. However, the fact that mental health and nervous system disorders are now high on the international health agenda is by no means a guarantee that the fate of patients suffering from these disorders in developing countries will improve. In most developing countries the treatment gap for mental and neurological disorders is still unacceptably high. To address this problem, an international network of collaborating institutions in low-income countries has been set up. The establishment and the achievements of this network--the International Consortium on Mental Health Policy and Services--are reported. Sixteen institutions in developing countries collaborate (supported by a small number of scientific resource centres in industrialized nations) in projects on applied mental health systems research. Over a two-year period, the network produced the key elements of a national mental health policy; provided tools and methods for assessing a country's current mental health status (context, needs and demands, programmes, services and care and outcomes); established a global network of expertise, i.e., institutions and experts, for use by countries wishing to reform their mental health policy, services and care; and generated guidelines and examples for upgrading mental health policy with due regard to the existing mental health delivery system and demographic, cultural and economic factors.

The appropriateness and use of focus group methodology across international mental health communities.

The ability to interpret collected data across international mental health communities often proves to be difficult. The following paper reports on the use and appropriateness of focus group methodology in helping to clarify issues that could help substantiate data collection and comparison across different cultures and regions. Field tests of the focus group methodology were undertaken in different regions and this paper describes an overview of the final field test in Sofia, Bulgaria. The findings and experiences with utilizing this methodology were incorporated in subsequent data collections.