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.

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.

Acute brief psychosis has a distinctive and benign long-term course when compared with other remitting psychoses. This finding supports the ICD-10 concept of a separable group of acute and transient psychotic disorders. To effectively separate this group, however, the ICD-10 criteria need modification.

ATPD criteria need refinement, especially in regard to duration. Further studies aimed at early detection and assessment of onset and duration of these disorders are needed.

Acute transient psychoses conform neither with schizophrenia of brief duration nor with atypical affective psychosis, and thus require separate classification as proposed in the ICD-10.

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.

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.

No abstract