Sequential respiratory, psychologic, and immunologic studies in relation to methyl isocyanate exposure over two years with model development.

Of 113 methyl isocyanate (MIC)-exposed subjects studied initially at Bhopal, India, 79, 56, 68, and 87 were followed with clinical, lung function, radiographic, and immunologic tests at 3, 6, 12, 18, and 24 months. Though our cohort consisted of subjects at all ages showing a varied severity of initial illness, fewer females and young subjects were seen. Initially all had eye problems, but dominant symptoms were exertional dyspnea, cough, chest pain, sputum, and muscle weakness. A large number showed persistent depression mixed with anxiety, with disturbances of personality parameters. The early radiographic changes were lung edema, overinflation, enlarged heart, pleural scars, and consolidation. The persistent changes seen were interstitial deposits. Lung functions showed mainly restrictive changes with small airway obstruction; there was impairment of oxygen exchange. Oxygen exchange improved at 3-6 months, and spirometry improved at 12 months, only to decline later. The expiratory flow rates pertaining to large and medium airway function improved, but those for small airways remained low. There were changes of alveolitis in bronchoalveolar lavage fluid on fiber optic bronchoscopy, and in 11 cases positive MIC-specific antibodies to IgM, IgG, and IgE were demonstrated. On follow up, only 48% of the subjects were clinically stable, while 50% showed fluctuations. Thirty-two percent of the subjects had lung function fluctuations. Detailed sequential behavior over 2-4 years was predicted for dyspnea, forced vital capacity, maximum expiratory flow rate (0.25-0.75), peak expiratory flow rate, VO2, and depression score. A model for clinical behavior explained a total variance of 52.4% by using the factors of cough, PCO2 and X-ray zones in addition to above five parameters. The behavior of the railway colony group (1640 patients) revealed a similar pattern of illness. When this observed pattern of changes was transferred to the affected Bhopal city sections (with an equitable age-sex distribution), our model results were again validated. Thus the picture of MIC-induced disease seems similar despite the differences for age-sex and initial severity of illness in our cohort and in the population of Bhopal city as predicted by our model.

Pre-pubertal bipolar disorder with 30-day spontaneous, classic, rapid cycles.

An 11 year old boy presented with 30 day continuous cycles of bipolar illness occurring regularly for 9 months without any genetic predisposition for affective illness. The patient was refractory to Lithium but Carbamazepine proved to be highly effective. The various unusual features of the case are highlighted and discussed.

Homosexuality : treatment by behaviour modification.

We present here the treatment of thirteen homosexuals by behaviour modification techniques. With classical electrical aversion and positive conditioning 8(61%) out of thirteen patients showed a change in orientation lasting on a six-month 1 year follow up. A marriageable age and indirect social pressures were positively correlated with improvement whereas the presence of a steady homosexual partner and habitual passive anal intercourse indicated a poor response. The techniques, the assessments, the onset and course of improvement and complications arc discussed. Our results and techniques are compared with those of other workers.

Male homosexuality : a psychiatric study of thirteen cases.

13 male homosexuals who approached us for treatment were studied. They came from unusual family back-grounds, had early homosexual experiences which were repeated and later became pleasurable. They showed a variety of homoerotic activity. Belonging to a marriageable age group, the social disadvantages of their homosexual behaviour prompted them to seek treatment. It was observed that early childhood experiences are important in the causation of homosexuality, early channelization of the sexual drive or to objects of the same sex by homosexual seduction and subsequent habituation also played an important part.

Delusional parasitosis--study of 3 cases.

Delusional disorder-somatic (parasitosis) type is a rare psychiatric disorder which poses a challenge to diagnostic and therapeutic skills. Pimozide, a highly specific dopamine blocker has shown promising results in the 3 cases illustrated here. These cases were seen over a period of 3 years. All the three patients believed that an insect has entered through the ear and is burrowing tracts/laying multiple eggs. They approached the ENT surgeons or neurosurgeon with a fear that their brain will be invaded. On psychiatric evaluation, no past or present history of major psychiatric illness was found. Premorbid personalities were well adjusted. Only for two patients, acute moderate stressors were detected. Delusions disappeared by the end of 2 wks but therapy was continued for 5 months.

Reevaluation of ECT in Schizophrenia: Right Temporoparietal versus Bitemporal Electrode Placement.

Two groups of schizophrenic patients received either bitemporal or right temporoparietal electroconvulsive therapy (ECT), both without anesthesia. Each patient received six treatments, the first three at 2-day intervals and the next three at 4-day intervals. Psychiatric evaluations and cognitive tests done at baseline, and 7 and 20 days after therapy, found similar degrees of improvement and similar effects on memory in both groups, with improvement in 40% and impairment in 30% of the patients. Subjective forgetfulness is more often experienced by the patients who receive bilateral ECT.

Evaluation of disulfiram in the treatment of alcoholism.

Seventy five male patients with the diagnosis of alcohol dependence syndrome were given disulfiram and an alcohol challenge was administered to all of them. They were kept on maintenance dose of the drug and followed up for six months, note being made of their improvement on several parameters, viz. the number of drinking episodes, the sevarity of reaction suffered, the side effects experienced etc. Twenty one patients were considered as drop outs and four were abstainent without the aid of the drug. 54 % of the fifty patients who continued taking the drug showed good to moderate improvement. 42% had one or more drinking episode while consuming the tablets. Older patients, and those brought by relatives and friends did better than the others. Results are discussed.

Evaluation of cognitive effects of ect (preliminary observations).

The aim of present double blind controlled study is to evaluate the effects of ECT in Schizophrenia and Depression. 20 depressed and 20 schizophrenic patients of either sex, in the age group 18 to 65 years fulfilling the inclusion and exclusion criteria were taken for study. The psychiatric evaluations were carried out before the treatment, and at the end of 3, 6, 8 and 10 treatments. Cognitive test battery was administered before the treatment and 48 hours after the last treatment. No Post ECT cognitive deficit was observed on the test battery though some patients did complain of forgetfulness subjectively.

Treatment of 26 cases of male sexual dysfunction by behaviour modification techniques.

26 married males with premature ejaculation and secondary impotence were subjected to behavior therapy. Relaxation, graded tasks, semans exercise, the squeeze technique, desensitization and thought stopping were the techniques employed. 15 (58%) of the patients improved. Factors contributing to success or failure are studied and the results compared with those of others using Behaviour Therapy.

Treatment of mental disorders in India.

1. Mental health gets a low priority all over the world but much more so in developing countries. 2. In India, modern psychiatric facilities are available only in the cities. Mental hospitals are becoming modernized but the backbone of psychiatry is the psychiatric department in the General Hospital where treatment is out-patient and family based except short admissions for crisis intervention. 3. Psychotropic drugs are preferred both by psychiatrists and patients, next being electroconvulsive therapy (ECT) and other physical treatments followed by psychotherapies. 4. In view of paucity of facilities, 80% of the population has to depend on indigenous treatments consisting of Ayurvedic and Unani systems of medicine, religious treatments consisting of prayers, fasting, etc. and various witchcraft and magical rituals.

Death, dying and near death experience.

Psychology of deaths due to acute medical emergencies is under-researched. Most studies till now have concentrated on extended-death situations like malignancy. This open pilot study of twenty five patients examines the psychological state of patients during a life threatening acute medical illness (Group A, ten patients) and of those who survive such an experience (Group B, fifteen patients). The study finds psychological exploration both possible and necessary if carried out in a discreet manner. Salient features of the interview technique are discussed. The study finds out whether patients are aware of the possibility of terminality. The psychological disturbances manifest and nature of care expected are also discussed. Near Death Experiences of those who acknowledge their occurence are reported. Some nuances of thanatological research are high-lighted: What are the abilities needed in an interviewer? Can such exploration increase psychological distress in a patient already prone to it because of serious medical sickness? What impact such research can have on the interviewer himself? The paper answers some of these common questions while developing the method of thanatological study in acute medical death-situations.

Value of the general health questionnaire in detecting psychiatric morbidity in a general hospital out-patient population.

On administering the General Health Questionnaire (GHQ) in English, Gujarati and Marathi, to 500 non-acutely ill adult patients selected randomly from a General Hospital Out-patient Department, it was found that 57% scored high (12 and above), indicating the possibility of psychiatric morbidity in this group. On subjecting 50 of these patients to blind psychiatric evaluation a misclassification rate of 30% was observed with respect to the G. H. Q. 96% of the psychiatrically ill scored high on GHQ, 37% of those scoring high on G. H. Q. were psychiatrically normal. If this misclassification rate is lowered by suitable modifications such as reducing items pertaining to Group A of the G. H. Q., then this test will be very useful as a simple tool to detect psychiatric morbidity.

Psychiatric morbidity among patients attending medical outpatient department.

Patients attending the General Medical Out-patient department of a public hospital were selected randomly and screened by a physician and a psychiatrist independently. The data on 258 patients reveal an overall psychiatric morbidity of 36% consisting of 24% pure psychiatric illnesses and 12% with associated organic problems. Females are found to be suffering from psychiatric illnesses to a statistically significantly greater extent as compared to males. Symptoms related to the head and the central nervous system, psychological symptoms and sleep disturbances are significantly more in the psychiatrically ill group. Functional patients have on an average more presenting complaints as compared to the "organic" i.e. physically ill patient (2.73 against 1.96). Other relevant findings are discussed in comparison with other studies.

Lithium in aggression.

Aggression is psychological and social menace. The safety of the patient as well as other members of the society is jeopardised due to severe acts of aggression. Hence control of aggressive behaviour gets a priority over various other symptoms. Various treatment modalities have been tried to control the act of aggression. We carried out this study to find out antiaggressive effect of lithium carbonate. Twenty resistant patients of varied psychiatric diagnosis showing aggressive behaviour completed this six weeks outdoor trial. They were started on lithium after initial assessment and were called once a week for evaluation with their relatives for total period of six weeks. Their lithium dose w,s adjusted and they were assessed on an aggression scale. We found clinical improvement in seventy percent of our cases. Our conclusion was that lithium has a definite role in controlling aggression.

Drug surveillance programme in psychiatry - adverse durg reactions.

In a clinically monitored surveillance of adverse drug reactions in a sample of 186 indoor patients in a general hospital over an average hospital stay of about two weeks, the following points were noteworthy. 32.8% of the patients reported side-effects and of these 79.3% were of mild to moderate intensity.Side-effects could be easily managed by specific antidotes and reassurance and permitted continuation of the same medication.There was no association between side-effects and socio-demography or clinical characteristics of the patient. Side-effects fitted in with the pharmacological profiles of the drugs used. In only 7.3% of cases was major treatment change made after the occurrence of the side effect. Improvement was independent of side-effects and no unusual or toxic reactions were seen.

An open trial of zuclopenthixol in management of acute psychoses : a multicentered study.

In an open trial, patients with ICD-10 diagnosis of acute functional psychoses were administered injection Zuclopenthixol acetate (Acuphase) in the initial phase. Patients were rated with CGI, BPRS -24 item and UKU side effect rating scale at baseJine, 24 hours and 72 hours. Of the 120 patients recruited, 119 finished this part of the trial. The most common side effect was sedation, which was preferable as most of the patients were in the acute state. The issues concerning less dosing efficacy and the rapid onset of antipsychotic activity are discussed.Patients who had been administered zuclopenthixol acetate in the acute phase were maintained with injection zuclopenthixol decanoate (depot) starting at 72 hours over the baseline. Patients were assessed at 72 hours, one week, 2 weeks, 3 vseeks, 4 weeks and 8 weeks using the same instruments. The issues concerning the dosage and therapeutic efficacy are discussed.