Emperor Ashoka: Did he suffer from von Recklinghausen's diseases?

Emperor Ashoka is widely regarded as one of the greatest rulers of India. This paper mainly deals with his medical condition as recorded in the Buddhist texts of Sri Lanka as well as in the Buddhist texts of North India and Nepal. These sources mention his skin disorder which is described as very rough and unpleasant to touch. He is also known to have episodes of loss of consciousness at various times in his life. One of the earliest representations of Ashoka, about 100 years after his death at one of the gates of Sanchi Stupa, shows Ashoka fainting when visiting the Bodhi tree and being held by his queens. In this sculpture, Emperor Ashoka is shown as a man of short height, large head and a paunchy abdomen. In this paper, it is speculated that Emperor Ashoka was probably suffering from von Recklinghausen disease (Neurofibromatosis Type 1), which could explain his skin condition, episodes of loss of consciousness (probably epilepsy) and other bodily deformities.

Hanuman Complex And its Resolution : An Illustration of Psychotherapy from Indian mythology.

The rich heritage of Indian mythology has been very little explored and used in psychotherapy in India. The present article deals with the story of Hanuman. How he lost the knowledge about his power to fly due to a childhood curse by Rishis and how he regained his powers when reminded by Jambavan during a crucial mission in search of Queen Sita, is the subject of author's description of Hanuman complex and its resolution. The author has often used this story in helping patients in psychotherapy as well as in teaching medical doctors and trainees in psychiatry. A plea is made for wider use of stories from Indian mythology in psychiatric practice.

Attitudes about schizophrenia from the pilot site of the WPA worldwide campaign against the stigma of schizophrenia.

BACKGROUND: A series of surveys were conducted to assess the attitudes of the public, and other groups, toward those with schizophrenia. The aim of these surveys was to aid in the planning and evaluation of the WPA anti-stigma initiative in Alberta, Canada. METHOD: A questionnaire was devised and administered via telephone to over 1,200 individuals in three Alberta cities, and in paper and pencil format to 40 members of the Schizophrenia Society of Alberta and 67 medical students. RESULTS: In contrast to some earlier findings, "loss of mind" was rated to be more disabling than any other handicapping condition. In general, respondents showed a relatively sophisticated understanding of schizophrenia and a higher level of acceptance than might have been predicted. Nonetheless, this acceptance was not as high for situations where closer personal contact was likely, and fears of dangerousness continue to be associated with schizophrenia. The majority of respondents, however, felt that treatment aided those with schizophrenia, expressed support for progressive programmes for the mentally ill, and stated that they would be willing to pay higher taxes so that programming could be improved. CONCLUSIONS: The results do not support the utility of a broad approach for an anti-stigma campaign, but rather suggest a more specific focus, such as perceived dangerousness.

Mortality and long-term course in schizophrenia with a poor 2-year course: a study in a developing country.

BACKGROUND: The short-term course of schizophrenia is reported to be better in some developing country settings. The long-term course in such settings, however, has rarely been studied. AIMS: To examine the long-term course and mortality of schizophrenia in patients with a poor 2-year course. METHOD: The report is based on two incidence cohorts of first-contact patients in urban and rural Chandigarh, India, originally recruited for the World Health Organization Determinants of Outcome of Severe Mental Disorders study. Patients were assessed using standardised instruments at 2- and 15-year follow-ups. RESULTS: Ninety-two per cent of the patients with a poor 2-year course had a poor long-term course and 47% died - a nine times higher mortality rate than among patients with other 2-year course types. CONCLUSIONS: In this developing country setting, a poor 2-year course was strongly predictive of poor prognosis and high mortality, raising questions about the adequacy of care for such patients.

Development of national mental health programmes in the countries of the eastern Mediterranean region.

In this paper, the need for all countries to tackle mental health problems is emphasized. The development of mental health services in the Eastern Mediterranean Region is discussed and national mental health programmes in the Region are described.

Development of National Mental Health Programmes in the countries of the Eastern Mediterranean Region

In this paper, the need for all countries to tackle mental health problems is emphasized. The development of mental health services in the Eastern Mediterranean Region is discussed and national mental health programmes in the Region are described

Fever and acute brief psychosis in urban and rural settings in north India.

BACKGROUND: This case-control study used data from Chandigarh, North India to investigate the association between antecedent fever and acute brief psychosis. AIMS: To assess whether antecedent fever may be a biological correlate of acute brief psychosis, and contribute to the nosology of acute brief psychosis. METHOD: The study was based in an incidence cohort from two catchment areas, an urban and a rural site, that were part of the World Health Organization Determinants of Outcome study. The cases (n = 17) met criteria for acute brief psychosis; controls (n = 40) were patients with other acute and subacute psychoses. The Life Events Schedule was used to determine the presence of antecedent fever. RESULTS: The crude odds ratio for fever as a risk factor for acute brief psychosis was 6.2 (P = 0.004). The odds ratio in a logistic regression analysis--adjusted for site, gender and CATEGO classification--was 11.2 (P = 0.003). CONCLUSIONS: Antecedent fever may be a biological correlate of acute brief psychosis. This finding supports the validity of this entity, and has implications for its aetiology and diagnosis.

Onset of acute psychotic states in India: a study of sociodemographic, seasonal and biological factors.

This is a comparative study of patients with acute-onset, non-affective, non-organic, remitting psychoses and with non-remitting or schizophrenic psychoses in India. Two groups of patients with acute remitting and non-remitting or schizophrenic psychoses were compared with regard to the following variables: month of onset of psychosis; presence of stress, particularly fever, within 4 weeks preceding the onset of psychosis; childbirth within 12 weeks preceding the onset of psychosis; gender differences. It was found that the acute remitting psychoses showed an overrepresentation of females, a higher frequency of associated stress preceding the onset of psychosis, more often had onset during the summer months, i.e. between May and September, and had fever and childbirth preceding the onset of psychosis in a significantly higher proportion of patients, compared to acute non-remitting psychoses or schizophrenia. The implications of the findings which point towards biological factors in the aetiology of acute remitting psychoses are discussed.

Long-term course of acute brief psychosis in a developing country setting.

BACKGROUND: This study in North India compared acute brief psychosis--defined by acute onset, brief duration and no early relapse--with other remitting psychoses, over a 12-year course and outcome. METHOD: In a cohort of incident psychoses, we identified 20 cases of acute brief psychosis and a comparison group of 43 other remitting psychoses based on two-year follow-up. Seventeen people (85%) in the acute brief psychosis group and 36 (84%) in the comparison group were reassessed at five, seven and 12 years after onset, and were rediagnosed using ICD-10 criteria. RESULTS: At 12-year follow-up, the proportion with remaining signs of illness was 6% (n = 1) for acute brief psychosis versus 50% (n = 18) for the comparison group (P = 0.002). Using ICD-10 criteria, the majority in both groups were diagnosed as having schizophrenia. CONCLUSIONS: Acute brief psychosis has a distinctive and benign long-term course when compared with other remitting psychoses. This finding supports the ICD-10 concept of a separable group of acute and transient psychotic disorders. To effectively separate this group, however, the ICD-10 criteria need modification.

Effects of level of socio-economic development on course of non-affective psychosis.

BACKGROUND: This study explored the relation of level of socio-economic development to the course of non-affective psychosis, by extending the analysis of urban/rural differences in course in Chandigarh, India. METHOD: The proportion of 'best outcome' cases between urban (n = 110) and rural (n = 50) catchment areas were compared at two-year follow-up, separately for CATEGOS+ and non-S+ schizophrenia. RESULTS: The proportion of subjects with 'best outcome' ratings at the urban and rural sites, respectively, was similar for CATEGOS+ schizophrenia (29 v. 29%), but significantly different for non-S+ psychosis (26 v. 47%). CONCLUSIONS: The fact that in rural Chandigarh, psychoses have a more favourable course than in the urban area may be explained in large part by psychoses distinct from 'nuclear' schizophrenia.

First-onset schizophrenia in the community: relationship of urbanization with onset, early manifestations and typology.

As part of a World Health Organization collaborative study in 12 centres in developing and developed countries within defined urban and rural catchment areas with populations of 348,786 and 103,865, respectively, a total of 155 and 54 cases of first-onset schizophrenia, respectively, were identified over a 24-month period by a comprehensive and active recruitment of all cases. Approximately 50% of the subjects in both cohorts were in the age range of 15-24 years. There was a preponderance of males in the younger age group and of females in the older age group. The majority of cases had no family history and had shown good adjustment in childhood and adolescence. The onset was much more frequently acute and much less often insidious in our samples and (more so in the rural cohort), compared to the figure for all developed countries' sites. With regard to early manifestations of the disorder, there was a much higher incidence of loss of interest in appearance and cleanliness, being irritable and angry without reason, and loss of appetite, sleep or interest in sex in both of our samples, and of being excited or overactive for days or weeks in our rural cohort than in the developed countries' centres as a whole. On the other hand, claiming impossible things, behaving as if hearing voices and feeling persecuted, harmed or bewitched were much less frequent in our rural cohort than in the urban cohort or the developed countries' centres as a whole. With regard to the clinical diagnosis of schizophrenia, paranoid, hebephrenic/disorganized and residual types were under-represented in our samples (more so in the rural sample), and catatonic type and acute schizophrenic episode were over-represented compared to the developed countries' centres. Moreover, the proportion of subjects of CATEGO class S+ was lower in our samples. With regard to onset, early manifestations and clinical subtypes of schizophrenia, our rural cohort deviated most from developed countries' centres as a whole, with our urban sample falling in between, thus indicating the role of socio-cultural factors in general, and urbanization in particular, in these variables in schizophrenia.