Unexplained somatic symptoms--diagnostic window for mental disorders.

Prevalence of common mental diseases eg, anxiety disorders and depression in primary care, general practice and specialists clinics is high but theirdiagnosis in these settings are poor, main reason being the absence of psychological complaints by patients. Such patients commonly present with physical symptoms suggestive of systemic diseases but examination and investigations often fail to substantiate organic basis of these so-called unexplained somatic symptoms (USSs). Several studies have shown that patients with USSs suffer from anxiety and depression. But these USSs are mostly misinterpreted or ignored by clinicians resulting in poor rates of diagnosis. The study objective was to devise algorithm for better and early diagnosis of. mental diseases in a specialist clinic practice setting. Common USSs were interpreted as regards their symptom-correlates both physical and mental and documented while taking detailed history, physical examination and needed investigations to diagnose systemic diseases. The study was in phases during three years and included 1297 patients in four cohorts which included one group of 154 patients with common USSs, treated with long term antidepressants. Data of all patients were recorded in microsoft excel spread-sheets for analysis. Commonest presenting USSs were so-called "gas", "acidity" and "dysentery" expressed in vernacular terms. On elucidation these were found to mean wide varieties of physical symptoms-complexes that were not typical of specific systemic diseases; 85% in one group and 73% in another with these USSs and their symptom-correlates when positively screened for symptoms of neurotic diseases (ICD-10) after detailed history taking were found to have anxiety and depression. Psychiatric comorbidity with systemic diseases was found in various percentages in three different cohorts when these USSs were properly evaluated. By patients' own assessments, 84.4%, 88% and 90% of those presenting with USSs of so-called "gas", "acidity" and "dysentery" (with their symptom-correlates) and who were put on three different low dose antidepressant treatment groups had satisfactory to good results so long as they were being taken regularly. These common USSs and the underlying physical symptoms-correlates were eponyms of anxiety disorders and non-major depression. General practitioners and specialists eg, gastroenterologists, cardiologists, neurologists, etc, should heed the USSs as the starting point for early diagnosis and treatment of comorbid mental disorders along with the systemic diseases for better treatment compliance and outcome and quality of life. Training of physicians and medical students in the diagnosis and management of patients with USSs should be emphasised in clinical teaching programmes. An algorithm for early diagnosis and management of common mental disorders in general and clinic practice is suggested.

Immunological studies on pulmonary tuberculosis: a preliminary report.

An investigation of 71 patients (61 mantoux positive and 10 mantoux negative) with bacteriologically and radiologically proven primary pulmonary tuberculosis was undertaken for immunological analysis to evaluate cell mediated (E-rosette) and humoral (EAC-rosette and serum immunoglobulins; IgG, IgA & IgM) immune status. 41 age and sex matched normal subjects served as controls. An inverse relationship between cell mediated and humoral immune response was observed in tuberculous patients in general. Defects in cell mediated immune response was pronounced in mantoux negative cases. Fractionation of serum protein revealed a significant diminution in albumin level with a concomitant elevation in globulins particularly gammaglobulin levels. It appeared that there is a definite need to boost up T-cell mediated responses and to control the over activity of B-cell in these cases. Proper handling of the immune system by appropriate therapy might change the course of the disease.