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Aim:To assess the health-care needs of the patients with severe mental disorders.Materials and Methods:Patients with the diagnosis of a severe mental disorder (schizophrenia and related psychotic disorders, bipolar disorder, recurrent depressive disorder, major depressive disorder and obsessive compulsive disorder) were assessed using Camberwell Assessment of Need-Research version (CAN-R) Scale and indigenously designed Supplementary Needs Assessment Scale (SNAS).Results:The study included 1494 patients recruited from 15 centers. The most common diagnostic group was that of affective disorders (55.3%), followed by psychotic disorders (37.6%). The mean number of total needs as perceived by the patients was 7.6 on the CAN-R. About two-third of the needs as assessed on CAN-R were met, and one-third were unmet. On CAN-R, main domains of needs as reported by patients were those of money, welfare benefits, transport, information about the illness and treatment, relief of psychological distress, company, household skills and intimate relationships. On SNAS, the mean number of total needs as perceived by the patients was 7.6 of which 4.1 were met needs. The most common domains of needs as assessed on SNAS were those of financial help, medical reimbursement, psychoeducation, free treatment, certification of mental illness, flexible work/job timings, addressing the caregiver stress and legal aid.Conclusion:About two-third of the needs, of the patients with severe mental disorders are met as assessed using CAN-R. However, higher percentages of unmet needs are identified on SNAS. In view of the commonly reported needs, a change in the orientation of services offered to people with mental disorders is very much called for. At the government level, desired policies must be formulated to support the patients with mental disorders.

This study aimed to assess the role of pleural fluid analysis in diagnosing pleural malignancy. Thoracentesis and closed needle biopsy of parietal pleura, using Cope's needle, were performed in 45 cases of pleural effusion coming to Department of Pulmonary Medicine. Samples were processed and studied as per standard methods. The male to female ratio was 4.6:1. Age range was 18-74 years. Two pleural effusions were transudates. Amongst the 43 exudates, 17 cases were malignant on pleural fluid analysis. Cytohistological correlation was 68.4% for malignancy. Adenocarcinoma was the most common malignancy. Pleural fluid showed good sensitivity, specificity and accuracy. In developing countries, where investigations and health facilities are inadequate and cost of treatment is un-affordable, careful analysis of pleural fluid still remains a very convenient, low-cost and safe investigation that helps in diagnosing cases of malignant pleural effusion. Its combination with pleural closed needle biopsy can further enhance its usefulness in diagnosing pleural malignant lesions.

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Aim:To study the health-care needs of the patients with severe mental disorders as perceived by their family caregivers and the treating psychiatrists.Materials and Methods:Caregivers of patients with severe mental disorders and their treating psychiatrists were assessed using Camberwell Assessment of Need-Research Version (CAN-R) scale and indigenously designed Supplementary Assessment of Needs Scale (SNAS).Results:The study included 1494 patients recruited from 15 centers. The mean needs as per the CAN-R, perceived by the caregivers were 7.8 and treating psychiatrists were 8.1. About one-third of needs were unmet. On SNAS, both caregivers and treating psychiatrists reported a mean of 7.9 needs, of which more than half were unmet as per the caregivers. As per the treating psychiatrists, 45.5% of the needs as assessed on SNAS were unmet. There was a high level of correlation between needs perceived by the patients, caregivers and the treating psychiatrists. On CAN-R, main domains of needs as reported by the caregivers were those of money, relief of psychological distress, information about the illness and treatment, welfare benefits, transport, company and food. As per the treating psychiatrists, the most common total needs identified were those of relief of psychological distress, welfare benefits, information about the illness and treatment, money, transport, company self-care and physical health. The most common domains of needs as assessed on SNAS as per the caregivers were those of free treatment, medical reimbursement, psychoeducation, financial help, social support, insurance, more time from the clinicians and travel concession. The treating psychiatrists identified dealing with caregiver's stress as the most common need.Conclusions:According to the family caregivers and treating psychiatrists, about one-third of the needs of the patients as assessed using CAN-R and about half of the needs as assessed using SNAS are unmet.

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