Outcomes of referrals over a six-month period to a mental health gateway team

Mental health policy in recent years has prescribed the role, function and form for services in England. Evidence of their effectiveness post-policy implementation has been limited to date and minimal guidance has been available on how services should operate together as whole systems. This paper reports findings from a study of referrals and their outcomes in respect of specialist community mental health services following implementation of national policy and its interpretation and configuration at a local level. Findings highlight that gateway workers configured as a team operating between primary and secondary care can effectively shield community mental health teams from high numbers of referrals that they would deem inappropriate. The study also identified the triage role of this service as being crucial to the effectiveness of developing and maintaining care pathways and also in potentially supporting the mental health capability of primary care.

Allelic variation in the cg2 gene does not correlate with chloroquine resistance among Indian Plasmodium falciparum isolates

The cg2 gene of Plasmodium falciparum has been proposed to be associated with chloroquine resistance. Here we describe PCR amplification and sequencing of all the four repeat regions (kappa (kappa), gamma (gamma), psi (psi) and omega (omega)) of this gene, from Indian isolates. There were variant forms for each of these repeat regions (two for kappa and gamma, and three for psi and omega) among the 123 Indian isolates of P. falciparum. Among these isolates certain forms of psi and omega repeats were uniquely present while some of the reported forms of the kappa and omega repeats were absent. The pattern of combination of all four repeat regions of cg2 gene (genotype) was analysed from 52 isolates. A total of 11 different genotypes were observed among these cases, of which 10 were unique to Indian isolates. Certain genotypes were more common than others. The nucleotide sequencing of all the four repeat regions revealed that Indian isolates have some unique repeating units within the gamma and omega domains. Altogether, the PCR and sequencing results showed that there was an unrelatedness between cg2 repeats and chloroquine resistance.

Complete nucleotide sequence of the 6 kb element and conserved cytochrome b gene sequences among Indian isolates of Plasmodium falciparum

The malaria parasite contains a nuclear genome with 14 chromosomes and two extrachromosomal DNA molecules of 6 kb and 35 kb in size. The smallest genome, known as the 6 kb element or mitochondrial DNA, has been sequenced from several Plasmodium falciparum isolates because this is a potential drug target. Here we describe the complete nucleotide sequence of this element from an Indian isolate of P. falciparum. It is 5967 bp in size and shows 99.6% homology with the 6 kb element of other isolates. The element contains three open reading frames for mitochondrial proteins-cytochrome oxidase subunit I (CoI), subunit III (CoIII) and cytochrome b (Cyb) which were found to be expressed during blood stages of the parasite. We have also sequenced the entire cyb gene from several Indian isolates of P. falciparum. The rate of mutation in this gene was very low since 12 of 14 isolates showed the identical sequence. Only one isolate showed a maximum change in five amino acids whereas the other isolate showed only one amino acid change. However, none of the Indian isolates showed any change in those amino acids of cyb which are associated with resistance to various drugs as these drugs are not yet commonly used in India.

Antiatherosclerotic effects of fish extract feeding in rabbits

The feeding of a fish extract, prepared by extracting whole fish with 80% ethanol, prevented abdominal, thoracic aorta and coronary atheroma in cholesterol-fed rabbits. Daily fish extract feeding reduced serum cholesterol and LDL-cholesterol levels by 41.8 and 38.0%, respectively. In addition, triglyceride levels were reduced by 52.8%. Hepatic and aortic contents of cholesterol and phospholipids approached normal levels in cholesterol-fed rabbits on the fish extract diet. Fish extract feeding induced a greater fecal excretion of cholesterol. Plaque formation was very little or absent in the aorta of fish-fed rabbits.

Psychiatric morbidity in the first-degree relatives of schizophrenic patients

First-degree relatives (FDRs) of 162 schizophrenic and 106 control probands were investigated [corrected]. Psychiatric morbidity was present in 34.8% of FDRs of schizophrenic probands and in 9.2% of FDRs of controls. There was significantly more psychiatric illness in the siblings and parents than in the offspring of both schizophrenic and control subjects. The morbidity risks for schizoid-schizotypal personality disorders, cannabis-use disorder and paranoid personality disorder were significantly higher in the FDRs of schizophrenic patients than in those of controls, suggesting a biological relationship.

Psychiatric morbidity in the families of paranoid and non-paranoid schizophrenia patients

A total of 1018 and 812 first degree relatives (FDR) of schizoprencies and controls respectively, were studied to find out the psychiatric morbidity in the families of paranoid and non-paranoid schizophrenia patients. The risk of schizophrenia and affective disorders was found to be independent of the probands subtype diagnosis. The risk for schizoid-schizotypal and paranoid personality disorders was found to be increased in the first degree relatives of paranoid schizophrenic, as compared to non-paranoid schizophrenic, thus suggesting that the psychopathology in the FDR may differ with the subtype diagnosis of the proband.

Clinical variables and platelet mao in schizophrenia

Platelet MAO activity was estimated in 60 male drug free schizophrenics and 26 controls matched for age. The paranoid group had significantly lower enzyme activity than the non-paranoid group and controls. Patients with premorbid schizoid personality had significantly lower enzyme activity than patients with non-schizoid premorbid personality and controls. A significant negative correlation between platelet MAO activity and severity and duration of illness was observed. Family history of schizophrenia, presence of auditory hallucinations and type and age of onset of illness were not related to platelet MAO activity.

Hypolipidaemic and antiatherosclerotic effects of plumbagin in rabbits

Plumbagin (2-methyl-5-hydroxy, 1:4 naphthoquinone) isolated from the roots of Plumbago zeylanica when administered to hyperlipidaemic rabbits, reduced serum cholesterol and LDL-Chol. by 53 to 86 percent and 61 to 91 percent respectively. It lowered cholesterol/phospholipid ratio by 45.8 percent and elevates the decreased HDL-Chol significantly. Further, Plumbagin treatment prevented the accumulation of cholesterol and triglycerides in liver and aorta and regressed atheromatous plaques of thoracic and abdominal aorta. Plumbagin treated hyperlipidaemic subjects excreted more fecal cholesterol and phospholipids. In conclusion-Plumbagin feeding brings about a definite regression of atheroma and prevents the accumulation of cholesterol and triglycerides in liver and aorta.

Platelet mao activity in subgroups of schizophrenia

Platelet MAO activity was estimated in 60 male drug free schizophrenics, 36 male drug free manics and 30 male normal healthy controls by Radio Isotopic Technique using (14)C Tryptamine Bisuccinate as substrate. There was no significant difference between the enzyme activity in the schizophrenic, manic and control groups. Platelet MAO activity in the disorganized catatonic and paranoid schizophrenics was significantly lower as compared to the enzyme activity in the manic and healthy control group. Platelet MAO activity appears to be related to subgroups of schizophrenia disorganized, catatonic and paranoid. Limitations and scope for future research have been outlined.

Factitious disorder-a case report

A case of factitious illness in a young village woman is described. She presented with multiple physical and psychiatric symptoms and had interpersonal and sexual problems. A simple behavioural approach was successful in ameliorating her symptoms.

Case report : grave's disease presenting as paranoid schizophrenia

The case of a 37 year old male is described who initially presented as paranoid schizophrenia unresponsive to anti-psychotic drug treatment and subsequently developed features of Grave's disease. Treatment with carbimazole alone improved his psychiatric symptoms.

C-nor-9,11-secoestranes as modified estrogens and fertility regulation

The synthesis of C-nor-9,11-secoestradiol (4) has been achieved from 17 beta-acetoxy-11-chloro-3-methoxy-C-nor-9,11-secoestra-1,3,5(10)-tr ien-9-one (1) through a sequence of reactions without affecting the stereochemistry of estradiol-17 beta. Removal of the 9-keto function of 1 by hydrogenolysis and its subsequent treatment with Na/NH3 gives C-nor-9,11-secoestradiol 3-(methyl ether) (3), which has been demethylated under alkaline conditions to furnish C-nor-9,11-secoestradiol (4). Pyridinium chlorochromate oxidation of 3 gives the corresponding 17-ketone 6. Jones' oxidation of 4 to the ketone 5 and reaction of 5 and 6 with lithium acetylide gives corresponding 17 alpha-ethynyl derivatives 7 and 8. Relative binding affinity to estradiol-17 beta receptors and uterotropic, antiuterotrophic, and antiimplantation activities of compounds 3-8 have been studied. The effect of conformational flexibility on ligand-receptor interaction of these compounds is discussed.

Life events in anxiety neurosis

The study was carried out on 84 patients of anxiety neurosis and 47 controls. Presumptive Stressful Life Events Scale (PSLES) of Singh et al. (1984) was utilized for eliciting life events experienced by patients and controls during life time and 6 months prior to the onset of illness by an open ended interview. The frequency and stress scores of total life event and different categories of life events undesirable, personal, impersonal, ambiguous and desirable, experienced during lifetime and 6 months prior to the onset of the illness were significantly more in patients than in controls. When individual events were analysed a statistical difference was observed with regard to 41 out of 51 life events. Out of these 33 events were common i.e., they were observed to be significantly more in patients than in controls both during life time and 6 months prior to the onset of the illness. Four events namely, suspension from job, theft or robbery, broken engagement or love affair and conflict over dowry were found to be significantly more in patients during life time. On the other hand, 4 other life events such as, major purchase or construction of house, failure in examination, appearing for interview and getting engaged or married were found to be significantly more in patients during the 6 months prior to the onset of the illness. Thus patients were observed to experience a variety of life events more often than controls.

Life event in anxiety neurosis: a study of the effect of intervening variables

This study was conducted on 84 patients of anxiety neurosis selected according to stringent selection criteria, PSE scale was utilised for eliciting information regarding experience of life events during life time and past 6 months. Life time stress score correlated positively with Hamilton anxiety score, while family jointness, social support and socio-economic status correlated negatively with the Hamilton anxiety score. Life time stress score, socio-economic status correlated positively with economic status and social support and social correlated positively with family jointness. 5 variables, life time stress score, recent stress score, socio-economic and economic status and social support, when considered, accounted for 50 % of the variability in the magnitude of illness. Amongst these variables life time stress score and family jointness turned out to be the most important. These findings highlight the significance of experience of stresses over life time in the production of anxiety of symptoms and also suggest that the joint family is a support system in our country and dilutes the effect of stressful life events on the individual.