Position statement and guidelines on unmodified electroconvulsive therapy.

BACKGROUND: In modern day psychiatric practice, it is assumed as a matter of fact that when electroconvulsive therapy (ECT) is administered, it will be administered under anesthesia and with succinylcholine (or its equivalent) modification. Yet, as surveys indicate, there is considerable practice of unmodified ECT in developing countries and, to a small extent, in the developed world, as well. MATERIALS AND METHODS: This document examines historical and recent literature on the geographical practice, physiology, efficacy, and adverse effects of unmodified ECT. Particular attention is paid to musculoskeletal risks. RESULTS: Although almost all the research is of poor methodological quality, there is a good reason to accept that unmodified ECT is associated with a wide range of adverse consequences, important among which are musculoskeletal complications, pre-ECT anxiety, and post-ECT confusion. However, it appears from recent data that these risks are not as large as historically portrayed. Possibly explanations are suggested, with seizure modification using parenteral benzodiazepines as a special possibility. CONCLUSIONS: Under exceptional circumstances, if ECT is strongly indicated and seizure modification with succinylcholine is not feasible, unmodified ECT, especially benzodiazepine-modified ECT, may be a viable option. A detailed set of recommendations for such use of unmodified ECT is proposed along with necessary checks and balances. This document has been approved by the Indian Psychatric Society, the Indian Association of Biological Psychiatry, and the Indian Association of Private Psychiatry (which commissioned the preparation of the document).

Open labeled, randomized, switch-over study of two fixed doses (10/15mg) of aripiprazole : to evaluate its safety and efficacy in the treatment of Indian patients of schizophrenia.

Aripiprazole is a new anti psychotic with a unique receptor binding profile that combines partial agonistic activity at D2 receptor and 5-HT 1A receptor and potent antagonism at 5-HT 2A receptor. This receptor profile makes it possible for it to act as a dopamine system stabilizer. Based on various short term and long term studies, aripiprazole has been found to be effective in schizophrenia and has no significant adverse effect on QTc prolongation, prolactin, serum lipids, and has a low potential for weight gain. Present study aims to evaluate the efficacy and tolerability of aripiprazole (10-15mg/day) in the treatment of Indian patients of schizophrenia and to see its effect on QTc interval, prolactin levels, serum lipids, plasma sugar and weight gain in these patients. Outpatients with an ongoing/newly diagnosed ICD-10 Schizophrenia (n=136) were randomly assigned to 10 or 15 mg dose of Aripiprazole for a period of six weeks. Clinical response was evaluated by the Positive And Negative Symptoms Scale (PANSS), Clinical Global Impression (CGI) scale and safety was evaluated by observing spontaneously reported adverse events and changes in various laboratory parameters. Switching schizophrenic patients to aripiprazole (10/15 mg) from both conventional and atypical anti-psychotics was safe and well tolerated. Six weeks after switching to aripiprazole, patients showed improvements in PANSS scores (P< 0.001), EPS, prolactin levels and weight over the baseline levels. No difference was seen in the 10 or 15mg dose groups. One hospitalization was reported (due to hepatitis E). Common side effects reported were insomnia, somnolence, nausea, vomiting and diarrhea. Aripiprazole is a safe and effective anti psychotic in Indian patients - both in newly diagnosed, as well as, in patients not responding to or intolerant to other available typical and atypical antipsychotics.

Fungal toxicity with special reference to mycotoxins.

Mycotoxins are fungal secondary metabolites formed by consecutive series of enzyme-catalysed reactions from a few biochemically simple intermediates of primary metabolism. These mycotoxins can enter the human and animal food chain by direct or indirect contamination. Mycotoxins are equally harmful to animal and human beings. Realizing the importance of mycotoxins to the health of man and animals there have been concentrated efforts to develop highly sensitive analytical methods for detection and proper determination of mycotoxins in food, mixed feeds and feed ingredients, animal tissue, blood, urine and milk. Most of the mycotoxins are identified and most current research on it is concentrated on increasing sensitivity accuracy and reproducibility and above all to decrease the time of determination. A detailed review of mycotoxin and their detection is summarised in the paper.

Psychological profile of females with chronic pelvic pain.

The study sample consisted of 90 females with nonorganic pelvic pain, selected from Gynecology OPDs of Smt. S.K. Hospital and Swami Dayanand Hospital. Majority of patients were young, married Hindu, illiterate, housewives, belonging to low socioeconomic group and living in nuclear families. Majority of the patients had pain that had lasted between 1 and 5 years. Pain was of dull, mild type. These patients scored significantly higher than controls in the free floating anxiety, somatization, depression and hysteria subscales of Middlesex Hospital Questionnaire. 54.4% of the patients in the study group scored between 8 to 15 on the Hamilton Rating Scale for depression.

Attention deficit disorder with hyperactivity among paediatric outpatients.

Out of 1,000 children (aged 3-12 years) screened in a paediatric outpatient department over a 3 1/2-year period, 112 were found to have attention deficit disorder with hyperactivity (ADDH). The prevalence of ADDH increased with age, from 5.2% in those aged 3-4 years, up to 29.2% in those aged 11-12 years. There were four times as many boys as girls with ADDH. ADDH was most common in first born children and those from a lower social class. Children with ADDH had a higher rate of complications during pregnancy and delivery relative to a comparison group. Delayed development, temper-tantrums, enuresis, tics, broken homes, persistent parental discord and psychiatric illness in parents were all more common in children with ADDH than in the comparison group.

The other side of abortion.

PIP: India's 1962 Medical Termination of Pregnancy Act allows abortions to be performed up to 20 weeks of gestation on medical, humanitarian, or eugenic grounds. Of the 406 million abortions that occur in India each year, 2.3 are induced. Women who obtain an induced abortion tend to be 21.30 years old, married, have at least 2 living children, are of relatively low educational status, are from the middle or lower socioeconomic strata, and are nonusers of contraception. Thus, abortion in India comprises a major method of fertility control; up to 80% of abortion patients were not using contraception. This phenomenon is extremely costly; an abortion costs about Rs 350, while 1 couple-year of contraceptive protection averages Rs 60. Induced abortion also carries psychological costs. Although the majority of abortion acceptors experience relief after the procedure, guilt, depression, and social and occupational sequelae are not uncommon. Moreover, women with adverse psychological reactions to abortion are at risk of nonuse of contraception and a repeat pregnancy. Women most at risk of an adverse psychological reaction to abortion are those who are unmarried, adolescents, strongly religious, and are undergoing the procedure against their wishes. While access to abortion should be protected in India, greater attention should be given to the factors that make it necessary, including illiteracy, nonavailability or lack of knowledge of contraceptive methods, inadequate follow-up of contraceptive acceptors, and poor motivation.^ieng

Psychiatric reactions in hysterectomy.

50 women undergoing hysterectomy at Smt. Surheta Kriplani Hospital, New Delhi, when compared with age and parity matched 25 control cases on neuroticism and depression scales showed statistically insignificant difference at various points of time. The improvement in both groups was insignificant one week after procedure but became significant after I weeks (p< 0.01). The neuroticism or depression in study cases was hardly attributable to hysterectomy. The marital as well as social adjustments after 4 weeks of procedure were either unchanged or improved. It is emphasized that an attempt should be made to identify the patients who are more prone to get psychiatric disturbance in order to prevent or minimise these psychiatric disturbances.

'Dhat' syndrome--a useful clinical entity.

48 consecutive male patients of potency disorders were examined and classified as 'Dhat' syndrome, impotence or premature ejaculation. The age range of these cases was found as 20-38 years (mean 23.5 +/- 3.3 years) while age of onset was 16-24 years (mean 20.6 +/- 4.5 years). Majority of cases were unmarried (54.2%) and educated 5th class or above (79.1%). 31 cases (64.6%) had Dhat syndrome with or without impotency and/or premature ejaculation while 7 cases (14.6%) had only premature ejaculation and 10 cases (20.8%) only impotence. The cases with 'Dhat' syndrome or with impotence scored maximally on neuroticism and depression scales. Neurotic depression was the commonest associated psychiatric illness (39.5%) followed by anxiety neurosis (20.8%) while 31.3% did not have any possible diagnosis. The common presenting symptoms of 'Dhat' syndrome include weakness (70.8%), fatigue (68.7%), palpitations (68.7%), sleeplessness (62.4%) etc. Among the four groups on the basis of type of treatment (antianxiety drug, antidepressant, placebo, psychotherapy), the best response was seen in those receiving antianxiety or antidepressant drugs while those receiving psychotherapy showed minimal response. 7 cases (14.6%) dropped out of treatment and the maximum dropout (40.6%) was seen in psychotherapy group.

Renal function after long term treatment with lithium.

Renal functions of 30 patients of manic depressive psychosis on long term lithium prophylaxis have been studied and compared with 15 age and sex matched patients receiving psychotropic drugs other than lithium. The urine output more than 2.5 L/day was seen in 12 patients (4(1% ) while impaired capacity to show urinary osmolality more than 500 m Osm/L after overnight fluid deprivation was seen in 6 patients. Creatinine clearance ranged between 70-106 ml/min (mean 89 ml/mt). Creatinine clearance less than 70 ml/nun was seen in 3 patients. The ratio of urinary and serum creatinine showed statistically significant (p< .001) low value in lithium treated group. There was also significant increase in mean uric acid excretion in patients on lithium therapy. It is recommended that inspite of serum lithium levels being in normal range, renal functions should be assessed regularly in order to avoid progressive impairment of renal functions.

A study of emergency psychiatric referrals in a government hospital.

The socio-demographic and clinical characteristics of psychiatric referrals in emergency O. P. D. of a teaching general hospital were studied from January 1986 to December 1987. The referral rate was 1.5%. The source, reason and purpose of referrals were studied. Hysterical fits, altered sensorium and excitements together constituted three fourth of all emergency referrals. The diagnosis of neurosis was made in one third of the patients and about one fourth of all patients were labelled as suffering from hysterical neurosis (fits being the most common presentation).

Psychiatric morbidity in patients attending medical opd.

Psychiatric morbidity was analysed in 5,000 female patients who attended medical OPD from July 1985 to July 1986. The Psychiatric illnesses were found in 932 patients (18.42%). The commonest age to have psychiatric illness was 21-30 years (58.8%), and neuroses constituted the most common psychiatric diagnosis (44.6%). Schizophrenia was the least common psychiatric illness (3.2%) in patients attending medical OPD.