Cognition denotes a relatively high level of processing of specific information including thinking, memory, perception, motivation, skilled movements and language. Cognitive psychology has become an important discipline in the research of a number of psychiatric disorders, ranging from severe psychotic illness such as schizophrenia to relatively benign, yet significantly disabling, non-psychotic illnesses such as somatoform disorder. Research in the area of neurocognition has started unlocking various secrets of psychiatric disorders, such as revealing the biological underpinnings, explaining the underlying psychopathology and issues related to course, outcome and treatment strategies. Such research has also attempted to uproot a number of previously held concepts, such as Kraepelin's dichotomy. Although the range of cognitive problems can be diverse, there are several cognitive domains, including executive function, attention and information processing, and working memory, which appear more frequently at risk. A broad range of impairment across and within the psychiatric disorders are highlighted in this oration. The oration summarizes the studies investigating cognitive processing in different psychiatric disorders. I will also discuss the findings of my own research on neurocognitive deficits in mood disorders, schizophrenia, obsessive-compulsive disorder, somatoform disorder, including studies on 'high-risk' individuals. Tracing the evaluation of neurocognitive science may provide new insights into the pathophysiology and treatment of psychiatric disorders.

Background: Recent studies have shown a high prevalence of depression and cognitive changes in patients with end-stage renal disease (ERSD) and renal transplant recipients. There are few data available on the cognitive and emotional changes in patients undergoing renal transplantation in India. Aim: To evaluate the changes in cognitive profile and depression in renal transplant recipients. Methods: Thirty consecutive patients undergoing renal transplantation were evaluated 1 month before and 3 months after successful renal transplant with Beck Depression Inventory (BDI), Weschler Adult Performance Intelligence Scale (WAPIS), Luria Nebraska Neuropsychological battery (LNNB) and Life satisfaction scale. Results: Our study revealed an 86.7% prevalence of depression in ESRD patients as compared to 56.7% in post renal transplant patients. Analysis of neurocognitive functions on LNNB did not reveal any significant impairment. Furthermore, analysis of the Life satisfaction scale revealed most of the patients scored high satisfaction levels despite the stress of their disease. Results on WAPIS brought out significant improvement in intelligence quotient (IQ) after renal transplantation. Conclusion: Successful renal transplant is associated with improvement in depression, IQ and life satisfaction.

Background: A chronic mental illness such as schizophrenia is a challenging task for caregivers especially in the current era of de-institutionalization. In India, few studies have attempted to directly determine the relationship between coping mechanisms and burden; in the West, studies have found that improved coping in family members can decrease the perceived burden. Aim: To evaluate the burden and coping of caregivers in relation to the level of functioning in patients with chronic schizophrenia. Methods: The sample was 100 patients with their primary caregivers attending a Psychiatry OPD. Patients were assessed on the Global Assessment of Functioning (GAF) scale while caregivers were administered the Burden Assessment Schedule (BAS) and Mechanisms of Coping (MOC) scale. Results: Fatalism and problem-solving were the two most preferred ways of coping. Problem-focused coping, i.e. problem-solving and expressive-action decreased the burden of caregivers, while emotion-focused coping, i.e. fatalism and passivity, increased it. As the level of functioning of the patient decreased, the significance with which the coping mechanisms influenced the burden, increased. The use of problem-solving coping by caregivers showed a significant correlation with higher level of functioning in patients. Conclusion: Coping mechanisms such as problem-solving can decrease the burden of illness on caregivers and may even improve the level of functioning of patients.

Background: It is believed that people lack sound knowledge and appropriate attitude towards electroconvulsive therapy (ECT). However, very little systematic research has gone into this area. Aim: To examine the knowledge and attitude of patients and their relatives towards ECT. Methods: A 16-item questionnaire with satisfactory face validity and content validity was constructed and translated into Hindi. It was then administered to 89 patients and 83 relatives attending the psychiatry services in a major hospital in north India. Results: More than 65% of the respondents in both the groups-patients as well as relatives-gave correct responses such as ECT is life saving, many times it causes temporary but not permanent memory impairment and that ECT is not a non-scientific treatment. There was non-significant disagreement between the two groups. Conclusion: The study is a preliminary exploratory one and is likely to give direction for further research with refined methodology.

Background: The introduction of atypical antipsychotics was a big step forward in the treatment of schizophrenia and other psychoses. Their limitations, however, became evident over time. Aim To study the causes of weight gain associated with the use of olanzapine-an atypical antipsychotic drug. Methods: Eighty patients fulfilling the ICD-10 criteria for schizophrenia, predominantly with negative symptoms, were included in this study to evaluate weight gain as an adverse effect of treatment with olanzapine in relation to age, gender, dose and body mass index (BMI). Sociodemographic data and baseline weight along with height (to calculate the BMI) were recorded before the initiation of treatment. The patients were administered a flexible dose of olanzapine (5-15 mg) as monotherapy. Pregnant patients, smokers and those with endocrine disorders, cardiac problems and organic brain dysfunction were excluded from the study. The increase in weight as a neuroleptic side-effect of olanzapine was recorded and analysed in relation to age, gender, dose and BMI. Results: Of the patients receiving olanzapine, 66.6% had a weight gain of 1-5 kg over a period of 4 weeks. The weight gain was not related to the dose of the drug or BMI. The interesting finding was that the increase in weight was significantly related to age ?40 years and female sex, indicating that women >40 years of age are more prone to gain weight with olanzapine therapy in comparison with women <40 years and men of any age group. Conclusion: The potential for weight gain associated with the use of atypical antipsychotics to cause long­term complications will need further study. Clinicians are encouraged to monitor weight, plasma glucose and leptin levels, and lipid parameters in patients receiving olanzapine.

Background: Acute and transient psychotic disorders (ATPD) have been characterized by the development of florid psychotic symptoms within 2 weeks and complete remission of symptoms. Although there are no definite guidelines, these are usually treated by antipsychotic medication. Aim: This preliminary study examined the effectiveness of olanzapine in paediatric ATPD. Methods: In this 6-week open trial of olanzapine in paediatric ATPD, the patients were rated weekly on the Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI) Scale and Dosage Record Treatment Emergent Symptom Scale (DOTES). Results: Twenty-three patients (11 males, 12 females; mean age 14.0±1.3 years; range 11-16 years) were included in the study. The mean olanzapine dosage was 12.7±3.9 mg/day (range 5-20 mg/day). All the patients showed significant improvement in 6 weeks. The results showed a significant decrease (p<0.0001) in scores of BPRS (mean at baseline 46.2±7.0 to 21.4±3.9 at week 6). Severity of illness (CGI) decreased from 4.7±0.8 to 1.6±0.9 in 6 weeks. Also, global improvement (CGI) showed marked improvement in 14 (60.9%), good improvement in 8 (34.8%) and minimal improvement in 1 (4.3%) patient. Some common side-effects were dryness of mouth (n=14, 60.9%), increase in appetite (n=12, 52%), weight gain (n=12, 52%) and drowsiness (n=8, 34.8%). No patient developed extrapyramidal symptoms. Conclusion: Olanzapine was safe and effective in paediatric ATPD.

Background: Individuals with chronic alcoholism show impairments in visual scanning, set-shifting and response inhibition abilities. Aim: To study the relationship between performance on tests of set-shifting and selective attention, and alcohol intake variables (duration of dependence, amount of alcohol intake, and duration of abstinence during the past year). Methods: In this cross-sectional, controlled study, inpatients from a tertiary care centre were selected. Thirty patients with alcohol dependence and 15 age-, sex- and education-matched normal controls were administered the Trail Making Test (TMT) and Stroop test to assess visual scanning, set-shifting and response inhibition abilities. The data were analysed using the χ² test, t test and ANOVA with post-hoc analysis. Results: The patient group performed poorly on all measures of the tests. The duration of dependence and the amount of alcohol intake (during the past 1 year) were not found to significantly affect the performance on the 2 tests. The duration of abstinence during the past 1 year was significantly related to performance on the Stroop test with patients having a longer duration of abstinence showing lesser impairment. Conclusion: Patients with a fewer number of days of alcohol intake during the past 1 year show relatively better visual scanning, set-shifting and response inhibition abilities.

Background: The recognition of physical illnesses by mental health professionals has important clinical implications. Aim: This study aimed to find the nature and prevalence of associated physical illnesses in psychiatric outpatients. Methods: Two hundred fifty consecutive psychiatric outpatients who fulfilled the inclusion criteria of the study were assessed in detail for associated physical illnesses. A conclusive physical diagnosis was based on the clinical history, general physical examination and investigation reports. Results: Forty-eight per cent of the patients were found to have associated physical illnesses. In about one­fifth of the total sample (n=51; 20.4%) the associated physical illness was diagnosed for the first time. Hypertension (29.1%), respiratory diseases (15%), anaemia (12.5%), diabetes mellitus (10%) and liver diseases (5.8%) were some common physical illnesses found in these patients. Conclusion: Common physical illnesses of psychiatric patients can be detected mostly by a careful history­taking checklist and physical examination. Psychiatrists must inculcate the habit of conducting a general physical examination of their psychiatric patients.

Aim: To evaluate the profile of psychiatric disorders in geriatric inpatients. Methods: A total of 528 patients (age 65 years and above) admitted to various departments of the teaching hospital attached to the Government Medical College, Amritsar from 15 September 2001 to 14 September 2002 were included in the study. Psychiatric assessment of patients was made on the basis of psychogeriatric assessment scales (PAS) and present state examination (PSE-ninth edition, 1974). The ICD-10 criteria were used for psychiatric diagnoses. General medical conditions were diagnosed by consultants of the respective departments. The patients were finally assessed by the consultant of the Department of Psychiatry. The obtained data were analysed using the chi-square test. Results: Of the 528 patients, 260 (49%) had psychiatric co-morbidity. The most common psychiatric disorder was depression (25.94%), followed by adjustment disorders (11%), anxiety disorders (4.54%), dementias (3.6%), delirium (3%), bipolar disorders (0.8%), and substance-related disorders (0.4%). Conclusion: The above findings emphasize the importance of consultation-liaison psychiatry, especially in geriatric patients.

Disulfiram is the drug that is commonly prescribed for the treatment of alcohol dependence syndrome, and transient functional psychosis has been reported as one of its side-effects. Enuresis is another rare adverse effect reported. This report discusses a case of acute psychosis and enuresis in a patient on disulfiram who had ingested alcohol.

The majority of cases of genital self-mutilation reported in the literature have been in patients with psychosis. We report an unusual case of genital self-mutilation in erectile disorder. It is suggested that genital self­mutilation may be a pathway out of diverse psychological disorders and in non-psychotic cases it could be an expression of a psychotic solution to a conflict and may be influenced by cultural factors.

Tuberous sclerosis is a rare disorder. Mental retardation, epilepsy, autism and hyperactivity are commonly reported neuropsychiatric disorders associated with tuberous sclerosis. Rarely, other psychiatric disorders such as psychosis, depression and anxiety associated with this condition have been reported in the literature. A case of bipolar disorder associated with tuberous sclerosis with onset of the first manic episode at the age of 7 years is reported. The possibility of tuberous sclerosis as one of the causes of secondary mood disorder in very young children is also discussed.

Progressive multifocal leucoencephalopathy (PML) may pose a clinical and diagnostic dilemma. The patient may remain in a protracted psychotic state with negative symptoms, without overt features of dementia. The condition blends with catatonia, and eventually with akinetic mutism in a patient of AIDS in the absence of clinical evidence of an immunocompromised state. The present case report highlights the need for an in-depth clinical, biochemical and MRI assessment of patients with catatonia and akinetic mutism. Stupor of an 'akinetic mutism' pattern seems an important indication for HIV screening, particularly in high-risk patients.