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.

Clinical efficacy of centporpazine-a new antidepressant.

Efficacy of centpropazine, a new antidepressant, has been evaluated in forty two patients of endogenous depression. The 4 week open trial was carried out in a dose-range of 40 to 120mg per day. A significant lowering of Hamilton Depression Rating Scale (HDRS) score was observed in 34 patient. The antidepressant effect could be detected in 9 patients within one week, in 28 cases in two weeks and in all the 34 patients by third week. Giddiness, headache, dryness of mouth and weakness were reported by 11 patients.

Biological study of alcohol dependence syndrome with reference to ethnic difference: report of a WHO Collaborative Study.

Inherited deficiency of acetaldehyde dehydrogenase type I (ALDH-I) was found in 43% (50/117) of normals, 33% (27/82) of schizophrenics, but only 4% (5/113) of alcoholics among Japanese. The ALDH-I deficiency was never found, however, in 146 mostly schizophrenic subjects from Europe (Basel, Moscow, Zagreb), Australia (Nedlands), India (Lucknow), Morocco (Casablanca) and Mexico (Mexico City). It was demonstrated that ALDH-I deficiency produces the flushing syndrome which inhibits the development of drinking habit and alcohol dependence syndrome.

Factors associated with the course and outcome of schizophrenia a multicentred follow-up study : result of five year follow-up.

This paper describes the results of a five year follow up study on factors associated with the course and outcome of schizophrenia conducted in 3 centers (Lucknow, Madras and Vellore) under the auspices of the Indian Council of Medical Research. 386 patients who satisfied well defined criteria of diagnosis and inclusion and exclusion criteria were studied. All patients were regularly followed up. 287 patients had complete follow up after 5 years. After 2 years, most of the active symptoms had subsided. At 5 year follow up, about 67% of the patients showed good outcome. Regular drug compliance, short duration of illness, absence of economic difficulties, absence of dangerous behaviour and delusions of presecution at intake; presence of agitation at intake; acute onset, absence of schizoid traits in personality, low level of education, rural background and lower age of onset were significantly related to good outcome. A combination of 8 factors could correctly predict the outcome in 80% of patients. The implications of the above findings are discussed.

Factors associated with the course and outcome of schizophrenia in India. Results of a two-year multicentre follow-up study.

The paper describes the two-year follow-up results from 323 out of 386 patients fulfilling a modified version of Feighner's criteria for diagnosis of schizophrenia, in Lucknow, Vellore, and Madras. There was remission in 66% of cases. Short duration of illness, consistent compliance with medication, positive attitudes of relatives and neighbours, absence of economic difficulties, increase in religious activities on the part of patients, a rural background, and a non-schizoid pre-morbid personality were associated with good outcome. Features of depression, dangerous behaviour, and absence of agitation were associated with poor outcome.

Repeated naloxone administration in schizophrenia: a phase II World Health Organization Study.

In the context of a previous WHO collaborative study, six research centers reported that naloxone (0.3 mg/kg) produced significant improvement in symptomatology in neuroleptic-treated patients. In the current Phase II WHO study, repeated (4 days) naloxone (0.3 mg/kg) administration was performed in schizophrenic patients (n = 43) from five WHO collaborating centers using a double-blind, placebo-controlled design. Both naloxone and placebo administrations were associated with significant reductions in symptoms. Naloxone, however, was not superior to placebo. These data are discussed in relation to endorphin hypotheses of schizophrenia.

Lithium and renal functions.

Thirty patients of affective disorder who were on lithium for a year and thirty patients on antidepressant were studied in detail for renal functions. Our observation is that lithium therapy does not lead to any deterioration in kidney functions. The results are discussed.

3H-spiperone binding in platelet membranes: a possible biological marker for schizophrenia.

High-affinity-specific 3H-spiperone binding to platelet membranes was carried out in 30 schizophrenic patients, without prior antipsychotic medication, fulfilling the Research Diagnostic Criteria, and in 30 matched control subjects. The psychosis was rated on the Modified Brief Psychiatric Rating Scale. Compared with healthy subjects, schizophrenic patients had significantly higher 3H-spiperone binding due to a lower dissociation constant (38%), i.e. increased affinity. No significant difference was observed in the maximum number of binding sites (Bmax) between the two groups. It is our contention that 3H-spiperone binding to platelets may be a biological marker for schizophrenia.

Antianxiety effect of cannabis: involvement of central benzodiazepine receptors.

The present work, involving clinical, behavioral, and biochemical studies, was undertaken to elucidate the probable mechanism of the observed antianxiety effects of cannabis. The population for the clinical study consisted of 50 male chronic cannabis users who were otherwise healthy and 50 matched controls. When evaluated on Taylor's Manifest Anxiety Scale (TMA), these subjects had low anxiety scores as compared with the controls. To explore the possible interaction of cannabis with the benzodiazepine receptors, behavioral and biochemical studies in mice were devised, involving acute and chronic cannabis administration. Behavioral study revealed that mice under chronic cannabis treatment scored significantly higher on foot shock-induced aggression, but this was significantly blocked by benzodiazepine receptor antagonist. Furthermore, chronic cannabis treatment significantly (p less than 0.001) increased the frequency of licking response periodically punished by shocks. This confirms the antianxiety effect of cannabis, which also appears to be mediated through a benzodiazepine receptor, as it was reduced significantly (p less than 0.001) by a benzodiazepine receptor blocker. Specific 3H-diazepam binding was carried out in frontal cortex to assess both the population and affinity of benzodiazepine receptors. Our results indicate that acute cannabis treatment has no significant effect, whereas chronic cannabis treatment significantly increased 3H-diazepam binding as compared with controls. Scatchard analysis further reveals that increased affinity is responsible for increased binding to these receptors. It is therefore our contention that the antianxiety effect of cannabis is mediated through central benzodiazepine receptors.

Epidemiology of depression in India.

Depressive disorders constitute one of the major mental health problems. The cross and intracultural differences in etiology, clinical features and course and outcome vary maximally in depressives than in any other mental illness, and epidemiological studies have been a major strategy to delineate the same. In this report the author has attempted to review available Indian epidemiological literature in the field of depressive disorders, and suggestions have been provided for improving the quality of future research in this area.

Depressive disorders in the developing world.

In order to find out whether the finding of different prevalence rates for depression in rural and urban areas of India is supported by a difference in symptomatology as well, 30 rural and 42 urban hospitalized MDP-Depressed patients were compared on Hamilton Depression Scale and Schedule for Standardized Assessment of Patients with Depressive Disorders. Symptoms of guilt, loss of concentration and memory were significantly more in urban patients whereas gastrointestinal somatic symptoms were significantly higher in rural subjects. The difference is probably due to urban subjects being more sophisticated, expressive and familiar with mental disorders as compared to rural patients who being more familiar with somatic illnesses tend to somatize their psychic distress.

Platelet mao activity in chronic schizophrenia.

Platelet MAO activity of 30 male drug free chronic schizophrenics (RDC), 30 male first degree relative of these patients and31 age matched male healthy controls was studied. Analysis of variance revealed that no significant differences existed between the three groups. There was high correlation between the enzyme activily of probands and first degree relatives. Presence or absence of auditory hallucinations, or paranoid features did not affect the enzyme activity significantly.