Viewed in the context of ever-expanding conceptual boundaries for the diagnosis of bipolar disorder including the spectrum concept of DSM-IV, or even beyond (Akiskal and Pinto, 1999), it becomes obvious that lithium is the treatment of choice in a minority' of patients only (Bowden et al, 2000). This article reviews what additional benefit atypical antipsychotics may provide in patients with bipolar disorder. Due both to tradition and to the regulatory requirements in the USA (FDA) and European Union (EMEA), the main target of clinical trials with atypical antipsychotics has been typical manic disorder. More recently, a significant subgroup of atypical patients, e.g., with mixed states, marked psychosis, or rapid cycling, have participated in these studies to allow an estimation of the value of atypical antipsychotics in these conditions. For the purposes of filing applications for registration with the regulatory agencies, the existing evidence is probably weak, however; from a clinical perspective, it is important that most atypical antipsychotics have also been tested in combination treatments. Finally, first data are now available on long-term prophylactic efficacy of atypical antipsychotics. These combined efficacy data definitely support the use of atypical antipsychotics in bipolar disorder, and it is now the time to collect more experience with these substances in severely ill patients in clinical settings.

Background: Measures of EEG during ECT, for example, smaller post-seizure fractal dimension have predicted antidepressant response. The earlier study on this subject used bilateral ECT. This study aims to examine if this finding holds good even for unilateral ECT, using both fractal dimension and spectral power analysis of EEG. Methods: Fifty-one right-handed, drug-free patients with major depressive disorder received right unilateral ECTs at 2.5 times their seizure threshold. A rater blind to the clinical data measured fractal dimension and spectral power of EEG during their second ECT. Depression was rated using Hamilton's Rating Scale for Depression at baseline and on the 3rd, 7th and 14th days following ECT. Results: Thirty-five good quality EEG recordings were analyzed. Seventeen patients reached criteria for early response of more than median percent improvement on HRSD on both 7th and 14th day. Univariate analysis showed smaller fractal dimension and spectral power (greater post-seizure EEG suppression) in early responders compared to the late responders. This was confirmed by multivariate discriminant function analysis. None of the other clinical, treatment or EEG parameters predicted early response. Conclusions: Effective seizure during unilateral ECT may be characterized by high post-seizure EEG suppression.

Aim: Tb compare the efficacy of electroconvulsive therapy (ECT) with risperidone in the treatment of lorazepam non-responsive catatonia. Materials and methods: Inpatients with non-affective catatonia (n= 18) non-responsive to at least five-day trial of lorazepam (6-8 mg/day) were randomised into two groups in a double blind randomised design. Written informed consent was obtained. Four were dropped from the trial as they were found to have depressive catatonia. One group received true ECT (thrice weekly, n=8) plus oral placebo while the other received sham ECT plus risperidone (4-6 mg/ day). Bush-Francis Catatonia Rating Scale (BFCRS) was administered twice weekly to assess improvement in catatonic symptoms over a period of three weeks. The two groups were compared using two-way RMANOVA. Results: BFCRS scores reduced markedly over treatment course and this reduction was more profound in the ECT group (p=0.035). Shorter the duration of illness greater was the response (lower scores of BFCRS). Conclusions: Superior clinical efficacy of ECT over neuroleptics in catatonia is confirmed by this randomized clinical trial.

Background : ECT, though not favoured in the West for treating schizophrenia, is regularly practiced in India for this indication, particularly in poorly responding/treatment resistant cases.Therefore, its role in treatment-resistant schizophrenia is a subject of systematic investigation. Aim : To compare the effectiveness and safety of Electroconvulsive therapy (ECT) in a group of treatment-resistant schizophrenia patients with a control group. Method : Eligible and consenting patients were randomly allocated to the ECT or Sham ECT groups. Both received antipsychotic drugs.Twenty-five patients completed the study (ECT, n= IS; Sham ECT, n= 10).The study was conducted in a double-blind manner. Clinical change was assessed weekly with BPRS, CGI and adverse event measures.ANOVA for repeated measures and other post-hoc comparisons were used for data analysis. Results: ECT treated patients improved significantly over successive weeks (p<0.002) after 6 ECTs, whereas the group receiving sham-ECT did not In both the groups, however, CGI scores did not change significantly, suggesting a dissociated response pattern. ECT was associated with greater relief among carers and lower rehospitalization. Conclusion : ECT augmentation may well have a significant impact on the clinical course of patients with treatment resistance schizophrenia. It is unclear, but possible, that these changes may be reinforced and maintained by maintenance ECTs. Replication of the present investigation and further studies on maintenance ECT would be rewarding.

Neuroleptic malignant syndrome (NMS) is an uncommon but potentially serious idiosyncratic response to neuroleptic antipsychotics. It usually affects young males, but the risk has been seen to increase with certain factors including the administration practices of antipsychotic neuroleptics in these individuals. Even though no predictors for NMS are yet known, this article highlights the findings on certain risk factors as seen from a series of fifteen patients who developed NMS. Cautious use of neuroleptics in those at risk, early recognition and institution of immediate management is important.

Personal characteristics of patients and environmental factors at psychiatric hospitals have been identified as predictors of absconding. This study seeks to establish a relationship between time of the year and absconding. All characteristics of absconders were analysed over a two-year period using hospital records (N= 104). Public holidays and lunar phases were obtained through almanacs for each year; and school vacation period was determined by reference to a school academic calendar. Friday was the most popular day of the week for absconding, males tend to escape more on the weekends compared to females, females tend to escape more during the wet season, and Christmas was the most popular holiday season for absconding to take place. The full moon phase had the largest percentage of absconding when compared to other phases. Recommendations are that the system of patient care should be client driven at all times and greater supervision of patients is needed on weekends, vacation periods and during the full moon phase.

With the aim of studying validity of Depression-Happness Scale (D-HS) in the assessment of bipolarity of affect in patients with remitted depression and its impact on quality of life, 31 patients of both genders, aged 17 to SO , fulfilling the ICD-10 criteria for recurrent deppressive disorder and bipolar affective disorder, currently severe depression and single episode severe depression were included in the study. Patients were rated on Hamilton Depression Scale (HDRS) on the third day of their admission.After treatment, when patients had remitted (either symptom free or 50% reduction in HDRS scores), D-HS and WHOBREF QOL were administered. Results indicated that the D-HS is valid measure of bipolar affect. Its correlation with final HDRS scores (r=-.356;P<05) and overall quality of life (r=.46;P<.0l) confirm the convergent and construct validity of D-HS . Implications are discussed along with the possibility of using D-HS for clinical and research purpose.

The aims of the study were (1) To analyse the temperament of children and adolescents presenting with Somatoform disorder and Dissociative (conversion) disorder and (2) To evaluate the nosological status of conversion disorder from the angle of temperament. Temperament of 30 children and adolescents having the diagnosis of either Dissociative (Conversion) disorder or Somatoform disorder were compared with temperament of 30 matched normal control groupTemperament was assessed by using Temperament Measurement Schedule (Malhotra, 1982). We found that children with Somatoform disorder and Dissociative (conversion) disorder had characteristic temperaments of low activity, low emotionality, low rhythmicity and low distractibility. Children with Somatoform disorder were less approachable than children with Conversion disorder, otherwise temperamentally there were no differences between these two disorders.

This prospective study was carried out in a service hospital, with the aim to study the prevalence and incidence of depression in pregnancy and postpartum period. Eighty Four consecutive patients attending the antenatal outpatient in the Obstetrics & Gynaecology department in their last trimester of pregnancy were recruited for the study. They were assessed on Beck Depression Inventory thrice viz. during third trimester of pregnancy, within 3 days of delivery (early postpartum period) & within 4-8 weeks of delivery (late postpartum period).The prevalence of depression was 8.3%, 20% and 12.8% respectively at three ratings. The incidence was 16% and 10% in the early & late postpartum period respectively. Further analysis revealed that depression in pregnancy correlated significantly with depression in early postpartum period, but not with late postpartum period. Depression in early postpartum period correlated with depression in late postpartum period.These findings have implications for early detection and care of women at risk for developing depression.

Poor outcome hebephrenic schizophrenia patients are clinically challenging. In this report, we demonstrate the usefulness of pimozide add-on thereapy to ongoing clozapine regime in a case who poorly reponded to clozapine, ECT and adequate trials with at least two conventional antipsychotics.

A 35 yrs, old male, a known case of Paranoid Schizophrenia for last 20 yrs, not respond to conventional anti-psychotics and was prescribed Olanzapine upto to 30mg/day. Patient developed manic symptoms during olanzapine therapy. He also showed a strong desire or sense of compu'sion to take the substance and progressive neglect of alternative pleasurable activities and fulfilled the criteria for dependence syndrome as per ICD-10 (WHO, 1992). This is a rare case of olanzapine induced mania along with abuse of olanzapine. This is suggested that during treatment with Olanzapine, the clinicians should be vigilant for mood changes and risk of olanzapine abuse.

Anorexia nervosa is regarded a s a typical culture bound syndrome, and its existence is negligible in nonwestern countries due to protective biological and socio-cultural factors. Most of the cases reported from nonwestern countries are atypical in presentation with lack of body image disturbances. Recent studies showed that anorexia nervosa is no more culture bound, in fact it is a "culture change syndrome" due to westernization and no differences are seen in the phenomenology of anorexia nervosa between the two cultures. We report a typical case of anorexia nervosa of binge eating and purging type associated with body dysmorphophobia in an adolescent girl.

Obsessive slowness is described to be a syndrome of extreme slowness in ways various tasks are performed. Its existence as an independent syndrome is challenged by authors, who regard it to be a part of obsessive compulsive disorder. Behavioural techniques of prompting, pacing and shaping are recommended for treatment of this condition. We describe here a case of a 21 year old male patient who presented with debilitating slowness. Patient responded to a combination of behaviour therapy (thought habituation and exposure) and pharmacotherapy (fluoxetine and thyroxine). Diagnostic difficulties and management issues are highlighted.

A case of Paranoid Schizophrania who developed Type 2 diabetes mellitus while on treatment with clozapine, is described. A brief review of literature is provided. In this case, Clozapine therapy could have caused the diabetes, or accelerated a pre-existing process.This report aims to highlight the importance of monitoring for hyperglycemia, an adverse effect of clozapine, which is being increasingly recognized in recent times.

Ziprasidone, yet another atypical antipsychotic, has been associated, in this report, with development of photo-allergic skin reaction in therapeutic doses