Background:Clozapine has been shown to be superior to chlorpromazine in improving the positive and negative symptoms of schizophrenia. However, technical experience with clozapine in Indian patients has not been documented.Aim:To assess the improvement in psychopathology of treatment-resistant schizophrenia with clozapine therapy and to study the relationship between sociodemographic and various psychopathology variables among patients with treatment-resistant schizophrenia.Methods:Twenty-two patients with treatment-resistant schizophrenia were evaluated using the Positive and Negative Syndrome Scale (PANSS) for schizophrenia, Calgary Depression Scale, Global Assessment of Functioning (GAF) Scale and Abnormal Involuntary Movement Scale (AIMS). These scales were used to determine the level of psychopathology, depression, overall functioning and severity of abnormal involuntary movements in the patients. The patients were admitted to the hospital for a short time to initiate clozapine therapy. At discharge, patients were stabilized on 300–400 mg/day of clozapine. The patients were re-evaluated after 20 months.Results:The study group showed better global functioning after clozapine therapy. The therapy was well-tolerated though moderate side-effects were seen. Suicidal thoughts declined with clozapine therapy. There was a significant reduction in the negative symptom and general psychopathology scores of PANSS.Conclusion:Clozapine has therapeutic efficacy in some but not all treatment-resistant patients with schizophrenia.

Electro Convulsive Therapy (ECT) is a medical treatment for severe mental illness in which small, carefully controlled electricity is applied to the brain. This electric stimulation is done in conjunction with anesthesia and muscle relaxant medications to produce a mild generalized seizure. This is used to treat a variety of psychiatric disorders. This is most effective in the treatment of severe depression providing a rapid relief. We report and discuss an unusual presentation of a ninety three year old lady with a diagnosis of Major Depressive Disorder, Recurrent, Severe with Psychotic features (296.34) who experienced musical hallucinations whilst she was treated on ECT. Clinically there was an inverse relationship between the biological symptoms of depression and musical hallucination during the ECT management. Though similar reports have never been reported earlier, we noticed a good association between the initiation of ECT and musical hallucination in our patient. The patient stopped experiencing musical hallucinations and improved of her biological symptoms of depression completely after the full course of ECT.

SummaryAttention-deficit hyperactivity disorder (ADHD) is an established diagnosis in children but there is a lack of agreement about its validity as a distinct entity in adults. Literature suggests that between one-third and two-thirds of children diagnosed with ADHD continue to manifest symptoms into adulthood. An adult diagnosis should be done on the basis of a thorough assessment, structured and semi-structured clinical interview, and with a complete understanding of the symptoms that manifest in adults. This may be supplemented by the use of rating scales. We present a review of the literature covering aetiology, clinical presentations, diagnostic evaluation and management of ADHD in adults.

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Lamotrigine, a new anti-epileptic mood stabilizer, with documented therapeutic benefits for refractory bipolar disorder [1], is reported to enhance clinical improvement in bipolar affective disorder when added to valproate therapy in adults [2]. The present report reveals the clinical efficacy and safety of such combination therapy for the treatment of paediatric bipolar affective disorder.A 71/2-year-old boy, RM, presented with DSM-IV bipolar affective disorder, mixed affective episode. His physical state and blood investigations were unremarkable, but electroencephalogram (EEG) showed generalized epileptiform (spike-waves) activities. He was commenced on sodium valproate 600 mg/day (20 mg/kg/day) along with olanzapine 2.5 mg/day, the latter being started for aggression. Due to lack of clinical response, at 6 weeks, lamotrigine was added to this regimen at a dose of 12.5 mg/day. The lamotrigine dose was gradually increased with 12.5 mg every 2 weeks and at 8 weeks of treatment, while on a dose of 62.5 mg/day, his symptoms remitted completely with no evidence of any adverse effects. Olanzapine was discontinued after 1 month on follow-up, and he remained symptom-free for the next 6 months.The report shows that lamotrigine add-on to sodium valproate therapy facilitated clinical remission and that this combination was well tolerated. The presence of EEG abnormalities could be considered a potential factor favouring clinical improvement with an anti-epileptic mood stabilizer therapy [3]. However, symptomatic remission in this patient, following combination therapy, suggests that the differential pharmacodynamic properties of valproate (GABA enhancer) and lamotrigine (sodium channel stabilizer) [4] could possibly have had a synergistic effect in facilitating clinical remission.