Eighty-two obsessional neurotics were studied from a phenomenological point of view in order to delineate the various forms and contents of obsessions and compulsions. An attempt was made to ascertain the frequency with which the different forms and content occur and their effect on the final outcome of the disorder. Five types of obsessions were identified: doubts, obsessive thinking, fears, impulses, and images, in order of frequency of their occurrence. Compulsive acts could be classified in two types, depending on whether they yielded to or diverted the underlying obsession. One-fourth of the patients displayed no compulsions. The content of obsession could be classified in five broad categories as relating to: dirt and contamination, aggression, inanimate-impersonal themes, religion, and sexual matters, in order of the frequency of their occurrence. The paper, while offering an interpretation of these findings, emphasizes the part played by socio-cultural factors in the character of an obsession's thought content. The absence of compulsions was found to be associated with good prognosis. A downward gradient was noted in the final outcome of patients without compulsions, those with controlling compulsions alone, those with both varieties of compulsions, and those displaying yielding compulsions alone, in that order. Based on this observation the paper suggests a prognosis-related hierarchical continuum of the severity of obsessional disorder.

The burden of care experienced by family members of 90 patients with major affective disorder was evaluated. The extent of burden in these families was considerable. The burden was significantly more among families of bipolar patients than those of major depression. Prolonged illness and high levels of dysfunction among patients correlated consistently with severity of burden. Severity of illness, higher age of the patient and number of episodes of the illness also influenced the extent of burden. Variables such as gender of the patient, religion, education, occupation, family type and size and the locus of control of both patients and relatives did not influence the extent of burden significantly. These results have substantial implications for the planning of intervention strategies.

The pattern of burden in 90 families with a neurotic patient, 30 each with dysthymia, generalized anxiety disorder and obsessive compulsive disorder was evaluated in this study. Burden was chiefly felt in four principal areas; financial burden, disruption of family routine, disruption of family leisure and family interactions. This pattern was similar among the three study groups. Analysis of problems perceived as burdensome demonstrated an increased concern among relatives regarding routine household matters, restricted leisure and ill effects of the patient's illness on the family atmosphere. Burden was significantly greater in cases of married patients, married relatives, housewives and employed patients. Such data, it is hoped, will help provide guidelines along which an enquiry into different aspects of burden can be conducted.

Quality of life (QOL) was assessed in three groups of patients, consisting of 30 schizophrenic patients with duration of illness <2 years, 30 schizophrenic patients with duration of illness > or = 2 years and 30 dysthymic patients. The diagnoses were made according to ICD-10. Two scales of quality of life were used, one of which was specific for schizophrenia, while the other was generic for all patients. On inter-group comparison the two schizophrenia groups did not show significant differences in quality of life, but on comparing schizophrenic and dysthymic patients, significant differences emerged. Dysthymic patients were significantly less satisfied than schizophrenic patients with duration of illness <2 years in the domain of physical health. In the domains of satisfaction with medication and leisure-time activities, both schizophrenic groups were significantly more satisfied than the dysthymic group. Comparison of the quality of life ratings of our patients with those of a well-known study from Sweden revealed some significant differences which relate to the domains of work, contacts, inner experience and leisure-time activities. Cultural factors are invoked to account for these differences. The need for refinement of assessment of quality of life in multi-racial and multi-ethnic contexts is stressed.

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