Forensic psychiatry in India current status and future development.

Forensic psychiatry is a developing superspeciality in India and other SAARC countries. After a brief historical review, the paper describes the current status of forensic psychiatry in India and compares it with the development in this field in Europe and America. It takes the stock of current scenario in three different areas viz., i) legal and clinical ii) teaching and training and Hi) research. It deliberates on need for teaching this subject at the undergraduate and the postgraduate medical and legal courses and necessity of full time consultants devoted to the practice of forensic psychiatry. It focuses on the recent developments in the field of forensic psychiatry like enactment of Narcotic and Psychotropic Substance Act (1985), Mental Health Act (1987), Juvenile Justice Act (1989), Act for the Disabled (1994) and the Consumer Protection Act (1986). The paper also recommends some strategies for teaching, training, research and future developments in this field.

Multicentric efficacy study of centpropazine and imipramine in depressed patients.

Centpropazine is a new antidepressant with minimal anticholinergic effects in preclinical animal models. In this study centpropazine has been compared with imipramine in a double blind randomized multicentric study. A total of 159 patients of major depressive disorder (79 in centpropazine group and 80 in imipramine group) from four centres were included in this trial. Each patient was randomised to receive either centpropazine in a dose of 40 to 120 mg per day or imipramine in a dose of 50 to 150 mg per day for a period of six weeks. The antidepressant efficacy of centpropazine was comparable to imipramine but anticholinergic side effects were four times less than imipramine. This establishes centpropazine as an effective antidepressant with remarkably safer tolerability profile.

Successful pregnancy in a separated conjoined twin.

A case of successful pregnancy in a separated conjoined twin is described. The patient underwent cesarean delivery because of the reconstructed pelvis and extensive perineal reconstruction, which resulted in dense fibrosis. Surgical records and communication with the patient's pediatric surgeons were helpful in planning for delivery.

Neuroleptic malignant syndrome (a case report).

An adult schizophrenic patient developed neuroleptic malignant syndrome following treatment with parenteral haloperidol. An early recognition of the syndrome, immediate discontinuation of the offending agent and prompt treatment with bromocriptine and lorazepam produced a good recovery. The various features of the case are discussed in view of the potential lethality of the syndrome.

A double-blind evaluation of alprazolam and imipramine in the treatment of major depression.

This report describes the results of a multicentre collaborative study comparing the safety and efficacy of alprazolam with imipramine in patients suffering from major depressive disorder. Two hundred and eight patients diagnosed as major depression as per DSM-III criteria were randomly allocated to alprazolam (N= 105) or imipramine (N = 103) in a double-blind fashion. Detailed assessments were carried out for a period of six weeks. Results revealed that alprazolam was as effective as imipramine as an antidepressant. Side effects were less frequently reported with alprazolam.

Pharmacokinetics of nitroxazepine in depressed patients.

A pharmacokinetic study was done on 10 depressed patients (DSM-III-R 296.3). The patients were treated with Sintamil (R) (nitroxazepine HCl) with titrated dose from 75 mg to 225 mg for 6 weeks. Plasma levels of nitroxazepine (Sintamil (R)) and its metabolites desmethyl (D), N-oxide (N-O) and carboxylic acid (c) were estimated. Anti-depressant efficacy was judged by reduction in Hamilton Rating Depression Scale (HDRS) scores, and tolerability was monitored by reports of unwanted effects.The overall reduction in HDRS score was about 50% by 6 weeks. The plasma levels of nitroxazepin (ng/ral) showed a rise from a mean ( +SEM) level. 47.0 4-7.3 on day 1 (dose 75 mg) to 129.84-24.6 on day 7 (dose 150 mg) (p< 0.01) and remained steady till day 21. There were large interindividual variations. The metabolites followed a similar pattern. The HDRS score showed a steady reduction between day 14 and 42 when the levels of nitroxizepine and des-methyl metabolites were maintained between 176.5 ng/ml to 251 ng/ml.

Pre-pubertal bipolar disorder with 30-day spontaneous, classic, rapid cycles.

An 11 year old boy presented with 30 day continuous cycles of bipolar illness occurring regularly for 9 months without any genetic predisposition for affective illness. The patient was refractory to Lithium but Carbamazepine proved to be highly effective. The various unusual features of the case are highlighted and discussed.

The beneficial effects of amineptine (Survector 100) in the treatment of depression: preliminary results of an Indian multicenter trial.

A multicenter study of the efficacy and safety of amineptine in the treatment of depression has been performed in India. Patients fulfilling the DSM-III criteria for depression were included in this open clinical trial and treated with amineptine for 6 weeks. They received one 100-mg tablet or two (100 mg) tablets of amineptine per day. Efficacy of treatment was assessed using the Hamilton Depression Rating scale on D0, D7, D14, D21, D35, and D42. Liver function and cardiovascular function were examined on D0 and D42 to assess possible adverse effect of treatment. The preliminary results in 32 patients showed that amineptine was effective as soon as the 7th day of treatment and that this effect improved continuously throughout the study. Amineptine was found to be safe.

Reevaluation of ECT in Schizophrenia: Right Temporoparietal versus Bitemporal Electrode Placement.

Two groups of schizophrenic patients received either bitemporal or right temporoparietal electroconvulsive therapy (ECT), both without anesthesia. Each patient received six treatments, the first three at 2-day intervals and the next three at 4-day intervals. Psychiatric evaluations and cognitive tests done at baseline, and 7 and 20 days after therapy, found similar degrees of improvement and similar effects on memory in both groups, with improvement in 40% and impairment in 30% of the patients. Subjective forgetfulness is more often experienced by the patients who receive bilateral ECT.

Cytotoxic reactivity of human natural killer (NK) cells during normal pregnancy: a longitudinal study.

A longitudinal analysis of natural killer (NK) cell-mediated cytotoxicity of maternal peripheral blood lymphocytes was carried out at various stages (16-36 weeks) of normal human pregnancy, within 1 week following delivery and up to 40 weeks post-partum. NK cell-mediated lysis of K562 target cells (TC) in short term 51Cr-release assays was significantly depressed throughout pregnancy, returning to control levels 9-40 weeks post-partum. Natural cytotoxicity of unseparated maternal peripheral blood was also substantially depressed at all stages of pregnancy and, in addition, remained impaired in the late post-partum period. Longitudinal enumeration of Leu 3a+ and Leu 2a+ lymphocytes indicated an absence of helper/suppressor T-cell imbalance during pregnancy, and analysis of Leu 7+ cells showed no difference in population sizes between control and pregnancy groups. Comparison of blood and lymphocyte cytotoxicity in control and pregnancy samples suggested a complex regulation of NK reactivity during pregnancy. The potential role in vivo of both plasma-associated and cellular regulatory elements is discussed.

Natural killer cells in normal pregnancy: analysis using monoclonal antibodies and single-cell cytotoxicity assays.

Peripheral blood lymphocytes (nylon wool non-adherent) from healthy pregnant women and normal non-pregnant females were tested for natural killer (NK) cell-mediated cytotoxicity against K562 target cells both by 51Cr-release assay and single-cell cytotoxicity assay in agarose. The results indicated depression of NK cytotoxicity in pregnancy due to a decrease in the proportion of target-binding lymphocytes as well as a reduction in the lytic capacity of target-bound cells. The ability of active pregnancy-associated NK lymphocytes to recycle appeared to be unimpaired. Analysis of lymphocyte populations with monoclonal antibodies recognizing NK cell-associated antigens showed that the number of Leu-11+ lymphocytes was reduced in pregnancy. Enumeration of Leu-7+ cells and correlation of NK cell subpopulation data with cytotoxicity assay data suggest that pregnancy is associated with a reduction in the number of mature NK cells and probably also an inhibition of post-binding lytic activity.