Vijoy K. Varma

Cannabis and cognitive functions: A prospective study

Psychological tests measuring intelligence, memory and other cognitive functions were given to 26 heavy cannabis users (mean duration of cannabis use 6.76 years; average daily intake 150 mg THC). Compared with a control group, the cannabis users were found to react slowly in perceptuo-motor tasks, but not to differ in intelligence or memory tests. The users suffered disability in personal, social and vocational areas and indicated higher psychoticism and neuroticism scores.

Cases of buprenorphine abuse in India

Buprenorphine was introduced as a potent analgesic with low abuse potential. Reports of buprenorphine abuse by opiate abusers have accumulated over the years, highlighting its use as a cheap alternative to heroin. The lower potency compared with heroin is being compensated by using a cocktail of buprenorphine with benzodiazepines or cyclizine. This study of 18 cases seen over 3 years broadly confirms these findings. Four cases reported haematemesis during acute withdrawal, a symptom not reported in earlier studies.

Cannabis Psychosis and Acute Schizophrenia

Twenty cases of cannabis psychosis were compared with a control group of 20 patients with ‘acute schizophrenic episode’ on a number of demographic, clinical, illness-related and outcome variables in a case-control study design using a retrospective chart review. The two groups were comparable on demographic, past and family histories of mental illness, premorbid personality, psychomotor activity, Schneiderian first-rank symptoms and mild cognitive deficits. The cases, in contrast to the control group, had a psychosis of shorter duration characterized by reactive and congruent affect, relative absence of schizophrenic formal thought disorder and a predominantly polymorphic clinical picture. Relapse was always preceded by cannabis use. This study suggests that, in spite of certain overlaps, ‘cannabis psychosis’ may still be considered nosologically distinct from schizophrenia in India. The implication of the study is that the role of cannabis in any acute psychosis should be investigated carefully so as to prevent an overdiagnosis of schizophrenia.

Onset of acute psychotic states in India : a study of sociodemographic, seasonal and biological factors

This is a comparative study of patients with acute‐onset, non‐affective, non‐organic, remitting psychoses and with non‐remitting or schizophrenic psychoses in India. Two groups of patients with acute remitting and non‐remitting or schizophrenic psychoses were compared with regard to the following variables: month of onset of psychosis; presence of stress, particularly fever, within 4 weeks preceding the onset of psychosis; childbirth within 12 weeks preceding the onset of psychosis; gender differences. It was found that the acute remitting psychoses showed an overrepresentation of females, a higher frequency of associated stress preceding the onset of psychosis, more often had onset during the summer months, i.e. between May and September, and had fever and childbirth preceding the onset of psychosis in a significantly higher proportion of patients, compared to acute non‐remitting psychoses or schizophrenia. The implications of the findings which point towards biological factors in the aetiology of acute remitting psychoses are discussed.

Correlates of early- and late-onset alcohol dependence

The present study aimed at finding out demographic, clinical, personality, and behavioural correlates of age at onset of alcohol dependence. Fifty-one male patients of alcohol dependence (DSM-III-R, APA, 1987) attending the drug de-addiction clinic of a general teaching hospital in India comprised the sample. They were administered a composite socio-demographic and alcohol use proforma, modified Sensation-Seeking Scale (SSS), Multiphasic Personality Questionnaire (MPQ), and a checklist of behavioural tendencies when drinking. The early-onset alcoholics (age at onset of alcohol dependence 25 years or less) were younger. They had a larger proportion of first-degree relatives with both lifetime use and abuse/dependence of alcohol but not of other psychoactive substances. They had experienced a greater number of alcohol-related problems in the previous 1 year. They were also higher sensation seekers, higher on the Psychopathic deviate scale of MPQ, and tended to display aggression, violence, and general disinhibition when drinking. The late-onset alcoholics (age at onset of alcohol dependence more than 25 years) were anxiety-prone and guilt-ridden, and had less alcohol-related problems. The two groups were comparable on duration, frequently, and quantity of alcohol consumption. The findings are discussed in relation to some of the recently proposed typologies of alcoholism.

Seasonality and affective disorders: a report from North India

Case records of the patients with major affective disorders (ICD-10 criteria), seen over a 5 year period in a busy clinic in North India were examined for Seasonal Affective Disorder (SAD) as per DSM-III-R criteria. In addition, seasonality of episodes of all affective disorders was also studied. Around 5.67% of the cases (n=44) retrospectively met the DSM-III-R criteria of SAD and predominant pattern was that of summer depression (n=18). There was also a consistent pattern of seasonal mania either in conjunction with seasonal depression (n=18) or in form of seasonal recurrent mania (n=11). None of the cases of depression showed any atypical vegetative features. In cases not meeting criteria for SAD (n=731), there was a trend for peaks for depressive episodes in winter followed by a smaller peak in summer months while manic episodes had peaks towards rainy and winter months. As compared to seasonal patterns of affective disorders in temperate zones, there was a general trend for opposite patterns of seasonality in SAD as well as in non-SAD. The findings are discussed in context of the climatic conditions of North India.

Course and outcome of acute non-organic psychotic states in India

This paper presents an overview of the diagnoses and short-term course of acute psychotic illnesses—affective as well as nonaffective—in a developing country setting. In the Chandigarh Acute Psychosis Study (CAPS) in Northern India, a cohort of 91 cases of acute psychotic illness were assessed for symptoms, diagnosis, and course ratings at multiple intervals over a 12 month period; cases were drawn from a rural and an urban clinic, permitting comparison of patients in these two settings. Non-affective (mainly schizophrenic) patients were found to be the predominant group (51%), followed by manic (26%), and depressive (19%) patients. Overall the acute psychoses had an excellent shortterm course and outcome, a result which held across all diagnostic groups and both the rural and urban setting. Rural and urban patients were similar in diagnostic distribution and course of illness. Investigations of such cases can expand our view of the possible manifestations and course of psychotic disorders, and may have implications for diagnosis.

Non-organic chronic intractable pain: A comparative study

&NA; This report compares patients with non‐organic chronic intractable (NOCI) pain with those having chronic pain associated with diagnosed physical illness though it was insufficient to explain the severity and nature of pain. Samples were selected after strict screening procedures. The results reveal that NOCI pain is more often seen in those who are younger, unmarried, with higher education and belonging to a professional group of occupation. Chronic pain associated with physical illness is reported more by elderly, married, those with lesser education and housewives. However, only slight differences were noticeable in the clinical characteristics of pain. Thus there are two distinct groups of chronic pain patients. These differences, along with less predominance of low back pain and high number of whole body pain in the samples suggest cultural differences in localisation and presentation of chronic pain.

Psychosocial and biological aspects of acute brief psychoses in three developing country sites

This study explored biological as well as psychosocial contributions to the incidence of acute brief psychoses in three developing country sites. The samples were taken from the five year follow-up data of the Internatinal Pilot Study of Schizophrenia sites in Ibadan, Nigeria and Agra, India, and from the Determinants of Outcome of Severe Mental Disorders rural Chandigarh site. Baseline narratives of the cases and controls were reviewed and rated for presence or absence of three exposures: fever, departure from or return to parental village (women), and job distress (men). Results showed an association between fever and acute brief psychosis in all three sites. There was an association between acute brief psychosis and departure from or return to the parental village among women in all sites, and among men, an association between job distress and acute brief psychosis was noted in Ibadan and Agra. These findings suggest that psychosocial and biological factors such as these three exposures merit further research to clarify their roles in the etiology of acute brief psychoses.

Course of Acute Affective Disorders in a Developing Country Setting

This report on the Chandigarh Acute Psychosis Study examines the early course of affective disorders of acute onset in a developing country setting. Forty-one cases of acute onset affective disorder (17 depressive and 24 manic subjects) were assessed at intake and evaluated at selected intervals up to 1 year. The rates of recovery and relapse and episode duration were determined for both the depressive and manic groups, and the relationship between possible predictors of outcome and the duration of the index episode was examined. All subjects experienced full recovery within the 1-year period. At 1-year follow-up, 71% of depressive patients and 75% of manic patients demonstrated no symptoms or social impairment. For depression and mania, respectively, the mean episode duration was 14.2 and 10.2 weeks, and the rate of relapse was 18% and 21%. Overall, these outcomes are considerably more favorable than in comparable studies of affective disorders in developed settings. Our findings suggest that acuteness of onset may be a major prognostic factor in predicting the course of affective disorders.