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This study analyses the predictors of response to electro-convulsive therapy in major depression The significance of the initial response to ECT as a predictor of outcome was also studied. 30 patients who met the diagnostic catena for major depression, single episode, as defined by DSM-IIIR were treated with 6-10 ECT sessions. Patients who had shown overall improvement by 50% or more on the Hamilton Depression Rating Scale (HDRS) were considered responders. 19 (63.33%) patients were responders while 11 (36.67%) patients were non-responders. These two groups differed significantly with regard to presence/absence of a delusion, diurnal variation of mood, and baseline HDRS score for hypochondriasis. Early improvement in depression was found to have a positive correlation with overall improvement in depression after the full course of ECT. Multiple linear regression analysis showed that approximately 56% of variability m outcome could be explained by the variables hypochondriasis, delusion and diurnal variation of mood taken together. A logistic regression model nosed on these 3 variables classified 83.3% of the patients correctly. The implications of these findings are discussed.

There is a good deal of research showing that suicide attempts increase markedly during adolescence. This study aims at studying the demographic and clinical variables of adolescent suicide attempters and comparing certain potential risk factors between adolescent and adult suicide attempters. It was found that adolescents in our study sample differ significantly from adults in the levels of depression, hopelessness, lethality of attempt and stressful life events. These findings are important in the practical management of adolescent suicide attempters.

In a prospective open trial, 30 inpatients with catatonic signs were treated systematically with oral lorazepam (dosage ranging between 3 to 8 mg/d) for a period of 5 days and subsequently with ECT if lorazepam trial failed. Outcome was monitored quantitatively during the treatment phase with Bush-Francis catatonia rating scale. In 21 out of 30 patients (70%), catatonic signs resolved with lorazepam trial. The response to lorazepam on Day 1, predicted the final outcome. Demographic variables, severity of catatonia or length of catatonic syndrome prior to treatment did not have any predictive value. Majority of the patients who showed an unfavourable response, did well with electroconvulsive therapy. A short duration lorazepam administration proved to be a safe and effective treatment for the catatonic syndrome.

In this study, the prognostic determinants were investigated involving bipolar patients classified into two groups-one with favourable course and outcome, and the other with clearly unfavourable prognosis, based on certain recommended criteria, with intermediate prognosis were excluded. As compared to the poor prognosis group, the good prognosis group had lower social dysfunctions, lower ratings on psychopathotogy fewer indicators of neurodysfunction in form of neurological soft signs (NSS) and tardive dyskinesia (TD). The poor prognosis group was characterized by: (i) older age at onset; (ii) more manic than depressive episodes (5:1) and (HI) lower levels of serum dopamine-β-hydroxylase activity (DBH). The association between poor prognosis bipolar disorder having neuroleptic intolerance (TD and NSS) with low serum DBH, suggests that it is genetically governed. Further research in this direction seems in order, particularly the follow up of first episode manic disorders.

One hundred wives of alcoholics with a confirmed diagnosis of alcohol dependence syndrome according to DCR 10 were studied with a "coping with drinking questionnaire". "Avoidance" was the most commonly endorsed coping behaviour. There was a significant correlation between all the coping components and alcohol related problems. No correlation was observed between neuroticism scores and coping behaviour. It is evident from the study that both personality and situational variables play a role in determining the coping behaviour of the wives of alcoholics.

A naturalistic, uncontrolled follow up study was carried out -in 60 cases of alcohol dependence syndrome diagnosed according to DSM-III-R at JIPMER.Pondicherry. At the end of one year, 32.5% of patients could he classified under abstinent and non prohlein drinker category. 35% continued to drink hut showed improvement in social and occupational functioning. 32.5% remained in the unimproved group. None of the preireatment variables could differentiate patients with favourable outcome from those with unfavourable outcome. Duration of disulfiram use was strongly associated with a favourable outcome.

The motivation of one hundred cases of suicide attempters was assessed clinically depending purely on their subjective reports. They were grouped into two, viz., those who primarily wished for a change (here in after called WC) and those who unambiguously wished to die (hereinafter called WD). They were compared with regard to the details of the attempt, methods of attempt, psychiatric and sociodemographic profile. The WC group was observed to have taken less precaution against discovery of their attempt, had low lethality with regard to the method used and had more adjustment problems than psychiatric diseases. They clearly belonged to the low risk group. The WD group had all these findings in the contrary, which put them in the high risk category. This simple way of assessing suicide risk may be having a face validity in the sociocultural context of the present.

Forty four patients attending the affective disorder clink at J1PMER Hospital who were on prophylactic lithium for bipolar affective disorder were studied, Intra-individual comparison for severity of illness was made between periods of similar duration with and without lithium prophylaxis. It was found that during lithium prophylaxis patients did significantly better on the following parameters: number of episodes of illness, duration of episodes, hospital admission, neuroleptic dosages and duration of antidepressant treatment. Of the 44 patients included in the study, 45% were good responders, 39% were partial responders and 16% were poor responders. Late age of onset was found to be a significant predictor of good response to lithium.

SUMMARY A five-year follow-up study of 38 patients with ‘psychosis not otherwise specified’ revealed that diagnostic change occurred in 34.2% of the patients. 15.8% of the patients developed schizophrenia and 18.4% developed affective disorders. The initial diagnosis was retained in 65.8% of the patients. The onset of the illness was acute in patients from rural background and this is statistically significant. 42% of the patients presented only catatonic signs, of which nearly 70% showed full recovery.