Background:Disability associated with mental illness is a major contributor to the global burden of disease. The present study looks at some aspects of disability associated with 7 psychiatric disorders: schizophrenia, bipolar affective disorder, anxiety disorders, depression, obsessive–compulsive disorder, dementia, and mental and behavioural disorders due to the use of alcohol.Aims:(i) To evaluate the nature and quantity of disabilities in the study groups; (ii) to compare the degree of disability with the severity of the disorder; (iii) to compare disability among various disorders; and (iv) to study the longitudinal stability of disability in the disease groups.Methods:A total of 228 patients attending the OPD, Department of Psychiatry, Assam Medical College, Dibrugarh, between July 2003 and June 2004, who were diagnosed as per ICD-10 guidelines and SCAN, were included in the study. Severity was assessed by the application of some commonly used rating scales for each specific disorder. The level of disability was assessed by using the Indian Disability Evaluation and Assessment Scale (IDEAS). Patients were followed up at 6 and 12 months. Statistical analysis was done on SPSS version 10.Results:All the 7 disorders under study are associated with significant disability; schizophrenia being maximally disabling. Disability associated with alcohol use disorder and anxiety is comparable to disability on account of OCD. Over a period of 12 months, disability due to depression, alcohol use disorder and anxiety tend to remain significant.

Abrupt clozapine withdrawal is heralded by both physiological and psychological symptoms requiring urgent management, out of which dystonic reactions have been reported by only two groups to date [Ahmed et al. 1998;Mendhekar and Duggal, 2006]. We present here the only case reported in the literature to manifest psychotic decompensation, oculogyric crisis and limb-axial dystonia in a single patient due to abrupt clozapine withdrawal and discuss the putative mechanisms underlying this unique presentation. Early recognition of this syndrome is important as symptomatic treatment alone runs the risk of recurrence of the withdrawal symptoms, as seen in our patient, unless clozapine is reinstituted promptly. Case reportMiss 'A' was started eventually on clozapine after sequential trials of trifluoperazine, flupentixol, haloperidol, chlorpromazine and amisulpiride failed to alleviate her schizophrenic symptoms. During her 18 years of diagnosed illness, all these medications were tried for adequate doses and duration, and polytherapy was also tried judiciously. But medication adherence was always erratic and eventual personality deterioration ensued over the years. She now needed assistance even for basic self-care needs and her clinical picture was dominated mainly by negative symptoms. Clozapine was titrated up to 400 mg in divided doses over 4 weeks and some response in self-care and communication was noted.After 6 months on clozapine, her carer stopped refilling her prescriptions and the patient's selfcare and socialization deteriorated further. She was restarted on clozapine and the target doses of 400 mg were achieved over 4 weeks. After 5 days on this dose, the treating team was alarmed by a sudden drop in her consciousness and axillary temperature rise of 101°F with total constipation. An abdominal lump was palpable and, on clinical suspicion of acute intestinal obstruction, all medications including clozapine were stopped considering its strong anticholinergic properties. All routine investigations including creatine phosphokinase (CPK), toxicology, virology and bacteriological scans came out to be within normal range and an abdominal computerized tomography (CT) scan diagnosed a large dermoid cyst.It was observed that 5 days following discontinuation of medications, the patient became acutely violent, assaultive, talked irrelevantly and showed inappropriate emotional reactions, and had to be calmed down by parenteral benzodiazepines. The very next day, she developed acute oculogyric crisis characterized by uprolling of the eyeballs sustained for 60-90 minutes at a time for 3 times over that day, and profound axial and lower limb dystonia. The dystonia was very severe with the patient shouting continuously in pain and was not able to move at all. Intramuscular promethazine 50 mg was administered and the dystonia disappeared in minutes. Her dystonia recurred the very next day and intramuscular promethazine 50 mg was repeated with prompt response. Detailed neurological examination revealed nothing except the focal ...

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IntroductionAssociation between leptin and ghrelin plasma levels and alcohol craving have been found in few studies but they have failed to differentiate this correlation with alcohol withdrawal state.ObjectivesTo research this correlation in a different population and to study this correlation with respect to hyper-excitable state of alcohol withdrawal.AimTo study levels of leptin and ghrelin in relation with alcohol withdrawal and craving.MethodsTwenty-five indoor patients fulfilling the alcohol dependence criteria were assessed for alcohol withdrawal symptoms and craving. Leptin and ghrelin levels were measured on 1st day, @ the end of 1st week, @ the end of 3rd week of stopping alcohol. Withdrawal was assessed using CIWA-A at day 1 and day 7, craving was assessed using PENN's scale of craving at the end of week 1 and week 3. Control group consisted of 15 first-degree relatives not taking alcohol.ResultsIt was found that leptin [t (38) = 2.95, P = 0.005] and ghrelin [t (38) = 2.56, P = 0.015] were significantly higher in alcohol-dependent patients. Levels of hormones had no significant correlation with alcohol withdrawal scores but had positive correlation with craving scores after abstinence.ConclusionsLeptin and ghrelin, known for balancing the energy homeostasis of body, also seem to play a role in pathways of drug dependence and craving. This relation is independent of stress hormone axis as leptin and ghrelin levels are not correlated with withdrawal scores, which is an indicator of stress hormone axis activation during alcohol withdrawal.Disclosure of interestThe authors have not supplied their declaration of competing interest.