Clinical sequelae of Japanese encephalitis in children.

Over a five and a half year period, virological investigations for Japanese encephalitis (JE) were conducted in children admitted with acute encephalitis like illness to a large city hospital. The diagnosis of Japanese encephalitis was made by viral isolation from cerebrospinal fluid and/or a four-fold or higher rise in haemagglutination inhibiting antibodies in paired sera followed by demonstration of specific IgM antibodies by HI test after treatment with 2-mercapto ethanol. All children surviving the illness were contacted by post and followed up for sequelae. A total of 55 children could be followed up after 12-18 months and 22 of these even after 2 yr. A high rate of major sequelae (45.5%) in the form of frank motor deficits (32.7%), mental retardation (21.8%) and/or convulsions (18.2%) was observed. Neurological deficits were of diverse types and improved even after 2 yr of the illness. Fourteen patients (25.4%) had only minor deficits in the form of scholastic backwardness, behavioural problems and/or subtle neurological signs. Only 16 (29.2%) patients were completely normal on follow up. JE may therefore be an important cause of neurological handicap in this area. Sequelae of the disease were more severe if the initial illness was prolonged (P < 0.001, CI 2.45, 12.64), or associated with focal neurological deficits (P < 0.001, CI 1.97, 7.02).

Pediatric depression and psychopharmacology.

Children can and do have depression which is similar to and continuous with that in adults. It can be diagnosed and treated similarly. Clinical evaluation reveals depression and laboratory tests are not required. It may be comorbid with other psychiatric or physical disorders. It causes considerable distress and impairment and suicide can be one serious sequel. Relapse or recurrences can occur. Etiology of depression is uncertain though hypotheses of psychogenesis or biogenesis exists. Psycho-pharmacological advances have helped in understanding etiology of depression and also in its effective treatment. So far, fluoxetine in the only antidepressant shown to be effective though others are also used. Antidepressants need to be given for one year or more.

Childhood autism in tuberous sclerosis.

The article reports two cases of childhood autism in tuberous sclerosis (TS). Certain atypical features are highlighted. The probands did not show the common seizure types associated with either TS or autism. No ventricular dilatation, cerebral atrophy or temporal lobe involvement was evident. The high prevalence of childhood autism in TS probands with moderate to severe mental retardation has been emphasized.

Behavior development in normal neonates.

The behavior of normal neonates was studied on day 3, 10 and 30 of life with the help of Brazelton's Neonatal Behavioral Assessment Scale (NBAS). The behavior items were clustered and each cluster was scored. The cluster scores increased on subsequent observations in both term and preterm neonates, the increase usually being significant. The corresponding cluster scores were significantly higher in term babies than preterms. Preterms with questionable delay in development at 3 months of age had significantly lower 30th day scores in 3 of the 7 clusters.

Mental health care : perceptions and expectations of rural population in uttar pradesh - a brief report.

National mental health programme envisaged integration of mental health care services into primary health care facilities. A house-to-house survey in 9 villages of a block situated near Lucknow city was conducted. A large number of villagers were aware of mental symptoms and indicated drugs as first choice of treatment. However, the majority preferred Government Hospitals and Private Doctors over Mental Hospitals and psychiatrists respectively. There was trend for utilization of available medical facilities but the community was largely unsatisfied with the available treatment facilities for mentally sick. The community suggests alternatives for the delivery of mental health care services based on their expectations. The results have been discussed vis-a-vis existing mental health care services.

Double-blind, placebo-controlled trial of clonidine in hyperactive children with mental retardation.

A 12-week, double-blind, randomized, placebo-controlled trial of oral clonidine in three fixed doses (4, 6, and 8 mcg/kg/day) using a crossover design was conducted with 10 children who had hyperkinetic disorder (mean age 7.6 years +/-.54). All had comorbid mental retardation. Both parents' ratings on the Parent Symptom Questionnaire and clinicians' ratings on the Hillside Behaviour Rating Scale showed a marked dose-related response to clonidine in hyperactivity, impulsivity, and inattention. Drowsiness was a common side effect of clonidine. It wore off by the 2nd to 4th week in most cases. Thus, clonidine is a safe and effective medication in young hyperkinetic children with comorbid mental retardation.

Pediatric depression and psychopharmacology.

Children can and do have depression which is similar to and continuous with that in adults. It can be diagnosed and treated similarly. Clinical evaluation reveals depression and laboratory tests are not required. It may be comorbid with other psychiatric or physical disorders. It causes considerable distress and impairment and suicide can be one serious sequel. Relapse or recurrences can occur. Etiology of depression is uncertain though hypotheses of psychogenesis or biogenesis exists. Psycho-pharmacological advances have helped in understanding etiology of depression and also in its effective treatment. So far, fluoxetine in the only antidepressant shown to be effective though others are also used. Antidepressants need to be given for one year or more.

Childhood autism in tuberous sclerosis.

The article reports two cases of childhood autism in tuberous sclerosis (TS). Certain atypical features are highlighted. The probands did not show the common seizure types associated with either TS or autism. No ventricular dilatation, cerebral atrophy or temporal lobe involvement was evident. The high prevalence of childhood autism in TS probands with moderate to severe mental retardation has been emphasized.

Behavior development in normal neonates.

The behavior of normal neonates was studied on day 3, 10 and 30 of life with the help of Brazelton's Neonatal Behavioral Assessment Scale (NBAS). The behavior items were clustered and each cluster was scored. The cluster scores increased on subsequent observations in both term and preterm neonates, the increase usually being significant. The corresponding cluster scores were significantly higher in term babies than preterms. Preterms with questionable delay in development at 3 months of age had significantly lower 30th day scores in 3 of the 7 clusters.

Clinical sequelae of Japanese encephalitis in children.

Over a five and a half year period, virological investigations for Japanese encephalitis (JE) were conducted in children admitted with acute encephalitis like illness to a large city hospital. The diagnosis of Japanese encephalitis was made by viral isolation from cerebrospinal fluid and/or a four-fold or higher rise in haemagglutination inhibiting antibodies in paired sera followed by demonstration of specific IgM antibodies by HI test after treatment with 2-mercapto ethanol. All children surviving the illness were contacted by post and followed up for sequelae. A total of 55 children could be followed up after 12-18 months and 22 of these even after 2 yr. A high rate of major sequelae (45.5%) in the form of frank motor deficits (32.7%), mental retardation (21.8%) and/or convulsions (18.2%) was observed. Neurological deficits were of diverse types and improved even after 2 yr of the illness. Fourteen patients (25.4%) had only minor deficits in the form of scholastic backwardness, behavioural problems and/or subtle neurological signs. Only 16 (29.2%) patients were completely normal on follow up. JE may therefore be an important cause of neurological handicap in this area. Sequelae of the disease were more severe if the initial illness was prolonged (P < 0.001, CI 2.45, 12.64), or associated with focal neurological deficits (P < 0.001, CI 1.97, 7.02).