BackgroundPoorly defined cohorts and weak study designs have hampered cross-cultural comparisons of course and outcome in schizophrenia.AimsTo describe long-term outcome in 18 diverse treated incidence and prevalence cohorts. To compare mortality, 15- and 25-year illness trajectory and the predictive strength of selected baseline and short-term course variables.MethodHistoric prospective study. Standardised assessments of course and outcome.ResultsAbout 75% traced. About 50% of surviving cases had favourable outcomes, but there was marked heterogeneity across geographic centres. In regression models, early (2-year) course patterns were the strongest predictor of 15-year outcome, but recovery varied by location; 16% of early unremitting cases achieved late-phase recovery.ConclusionsA significant proportion of treated incident cases of schizophrenia achieve favourable long-term outcome. Sociocultural conditions appear to modify long-term course. Early intervention programmes focused on social as well as pharmacological treatments may realise longer-term gains.

This study reports on the findings from a WHO sponsored cross-national investigation of life events and schizophrenia. Data are presented from a series of 386 acutely ill schizophrenic patients selected from nine field research centers located in developing and developed countries (Aarhus, Denmark; Agra, India; Cali, Colombia; Chandigarh, India; Honolulu, USA; Ibadan, Nigeria; Nagasaki, Japan; Prague, Czechoslovakia; Rochester, USA). On a methodological level, the study demonstrates that life event methodologies originating in the developed countries can be adapted for international studies and may be used to collect reasonably reliable and comparable cross-cultural data on psychosocial factors affecting the course of schizophrenic disorders. Substantive findings replicate the results of prior studies which conclude that socioenvironmental stressors may precipitate schizophrenic attacks and such events tend to cluster in the two to three week period immediately preceding illness onset.

The use of drugs (as intoxicants) is universal; the hedonistic use of such drugs has led to their abuse, and has always been a social problem. Although the indulgence in some drugs is confined to certain cultures, others like alcohol have been commonly used all over the world. Alcohol, opium, hemp (cannabis and its several preparations) have been widely used for their exhilarating qualities.

This sub-study of the WHO Determinants of Outcome of Severe Mental Disorders research project was aimed at characterizing the behavioral and expressive qualities of schizophrenia in two highly diverse cultures. Early research has indicated that the core elements involving affect, perceptual and cognitive dysfunction in schizophrenia are highly similar in form in most cultures of the world. Much of the cross-cultural literature emphasizes, however, strong differences in the ways in which schizophrenia is actually expressed and manifested in different settings. The basic methodology for psychiatric description and diagnosis in the WHO program was the Present State Examination. In five of the field centers a method for investigating the expressive quality and the social behavior of patients in their own communities through the eyes of significant others was applied. This method was then subjected to psychometric tests of cross-cultural applicability and found to be valid for comparing behavior across settings. The expressive patterns of the Indian and Nigerian patients were studied from two perspectives. Indian schizophrenics were described by family members as manifesting a more affective and "self-centered" orientation; the Nigerian patients presented with a highly suspicious, bizarre, anxious quality to the basic behavioral pattern. The main features of pathology were in general accord with the descriptions of indigenous psychiatrists. The special qualities of the psychosis in the two cultures were interpreted against the background of traditional psychopathological and anthropologic theories concerning the psychodynamics and the influence of differing social conflictual themes in the two cultures. Analysis of psychopathology in this manner was found to enhance understanding of underlying mechanisms and the role of cultural conflicts in its expression.

The course and outcome at a 13-14-year follow-up of the Agra cases in the International Pilot Study of Schizophrenia (IPSS) was observed by two methods: i) through a mailed questionnaire to assess the key respondents own perception of their state, ii) by a thorough clinical examination and assessment using standard instruments. The results of these two methods were compared and no significant difference found. Based on the second method it was found that 46% of schizophrenics and 43% of manic-depressives had one or two episodes during the first 5 years after inclusion and none in the subsequent period of 8 to 9 years (up to the present follow-up). The results indicate that the illness loses its intensity over a period of years. Mortality among schizophrenics was higher than the expected rate in a general population. The suicide rate was similar to that reported in other studies.

This is a report on the study of the prevalence and pattern of the use of dependence‐producing drugs on 1,192 postgraduate students from the faculties of Arts, Science and Commerce and final year undergraduate medical students. The overall prevalence rate of drug use was 50.08 % (65.22 % in medical and 34.85 % in non‐medical students). The highest drug use (76.43 %) was among male medical students. Male students preferred to use alcohol and bhang while femala had a preference for meprobamate followed by alcohol. In the majority of cases, the age of initiation was in the “teens”. “Friends” were most responsible for suggesting drug use, although “more than one” influencing agents out‐numbered all the single influencing agents. Parents were found to have a significantly “tolerant” attitude towards drug use by their off‐spring. “Personal reasons” were not responsible for indulgence in or abstaining from drug use. L.S.D. users had the maximum number of after‐effects. The effects experienced in respect of most drugs were generally unpleasant and sometimes contrary to the expectations of users. Most “non‐users” and “infrequent users” did not favour self‐decision for drug indulgence though some “moderate” and “frequent” users were in favour of giving this freedom for some substances. Stringent measum against drug use among students were advocated by all drug users.More males, particularly male medical students, than females reported drug experience. Among male users, religion, caste, earlier education, residence (both sexes), employment status, occupation of the father, parental education and family income (among females as well) were the variables found to be significantly associated with drug use.

This report is based on the findings of an epidemiological study of 29,468 rural, semi-rural and urban inhabitants of the Agra region of Uttar Pradesh. The survey was made in order to find out the prevalence of severe mental disorders and associated conditions in an Indian community. The sampling was purposive and areas selected were contiguous. Census methods were used. All inhabitants were investigated by a team consisting of a psychologist, a statistician, social workers and psychiatrists. After reconnaissance and initial contact by home visits, suspected cases were detected by a searching inquiry and the information so obtained was carefully documented. These cases were subjected to psychiatric examination and abnormal ones identified. Consultation with another psychiatrist was necessary to make a final diagnosis.The lifetime prevalence rate of schizophrenia was 2·2 per thousand, about the same frequency as found in other parts of the world. The maximum number of cases occurred in males between the ages of 15 and 24 and in females between the ages of 35 and 44. Single people, that is, never married, widowed, divorced or separated suffered significantly much more from the disease than bachelors and married people. A significant relationship was found between schizophrenia and castes in Vaish and Brahmin males as compared with others. The highest rate of schizophrenia was found among people in unremunerative status. Intoxicants were used more by schizophrenics than by normal people. Caste group indulgents had their own preferences in drug use, cannabis indulgence being highest among Brahmins. No association of schizophrenia with residence, educational status or sex was found.

The basis of human personality as given in ancient Hindu Ayurvedan literature is reviewed and interpreted in the light of current knowledge and understanding. The structure of mind expounded in Sankhyan philosophy is explained and its parallelism with the Freudian approach is brought out. The formative influences in the development of the mental constitution of an individual are described. An attempt is made to demonstrate close similarity between Ayurvedan and Lewin's field (Gestalt) theories. Significance of Tridosh (Vet, Pitta and Kaf), by vitiating the chemical balance, as etiological factors of mental illness is described. Sixteen personality types and their correspondence with 16 types of mental disorders are mentioned.