document resume - eric · document resume ed 289 320 ec 201 281 author reddy, g. n. narayana, ed.;...

DOCUMENT RESUME

ED 289 320 EC 201 281

AUTHOR Reddy, G. N. Narayana, Ed.; Gopalakrishna, N., Ed.TITLE A Decade of NIMHANS (1975-85).INSTITUTION National Inst. of Mental Health and Neuro Sciences,

Bangalore (India).PUB DATE 86NOTE 118p.PUB TYPE Reports - Descriptive (141)

EDRS PRICE MF01/PC05 Plus Postage.DESCRIPTORS Educational Facilities; Foreign Countries; Medical

Services; *Mental Disorders; *Mental Health;*Neurological Impairments; *Neurology; ProgramDevelopment; *Research and Development Centers

IDENTIFIERS India; National Inst Mental Health Neuro Sciences(India)

ABSTRACTThe development of the National Institute of Mental

Health and Neuro Sciences (NIMHANS) in Bangalore, India, ischronicled over its 10-year history. The volume begins with anexamination of the Institute's organization and administration,funding, staffing, teaching activities, etc. Subsequently, reportsfrom 26 departments of NIMHANS are included, specifically:psychiatry, clinical psychology, neurology, neurosurgery, psychiatricsocial work, neuroanesthesia, speech/hearing and language, nursing,physical medicine and rehabilitation, neuroradiology, neurochemistry,neuropathology, microbiology, neurovirology, psychopharmacology,neurophysiology, biophysics, biostatistics, cytogenetics, centralanimal research facility, library and information services,publications, medical illustration and audiovisual aids, biomedicalengineering section, engineering section, and Ayurvedic research.Each departmental report contains a description of manpowerdevelopment activities, clinical services, recent research studies,and future plans. (JDD)

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Objectives of NIMHANS

1. To promote the growth and development of mental health and neuro sciences.2. Develop the Institute into an advanced service, post-graduate training and research

centre.

3. Enquire into the molecular, neuro-physiological, psychological, sociological andtranscendental aspects of the brain-Mind behaviour axis and to evolve suitabletechniques for application in day-to-day problems.

4. Provide and assist In the activities of research, evaluation, training, consultation andguidance related to mental health including biological, pFychological, sociological andclinical aspects.

5. Conduct experiments and develop patterns of teaching in under-graduate education inall branches of mental health and neurological sciences by opening training centres andinstituting innovative schemes.

6. Attain self-sufficiency in post-graduate education in all branches of mental health andneuro sciences in India.

7. Develop courses and curricula in all branches of mental health and neuro sciences forunder-graduate and post-graduate teaching.

8. Develop community mental health models and programmes of services,demonstration,training and research in bcth urban and rural areas.

9. Undertake, publication of journals, research papers, leaflets and text books and augmentand maintain library information services in the furtherance of the objectives of thesociety;

10. Collect, organise, disseminate and publish knowledge about mental health and neurosciences.

V

11. Educate the public in mental health and neuro sciences.12. Invite representatives of Governments, Universities, other organisations and

outstanding scientists from India and abroad to participate in the programmes of theInstitute.

13. Co-operate wit}' rnational and national agencies engaged in mental health and neurosciences research' 4 training and arrange for inter-change of personnel, material anddata.

A DECADE OF

NIMHANS,(19'th-95)

1986

National Institute ofMental Health & Neuro ScienCes

Bangalore-560 029 INDIA

4

Edited and Published byDr. G. N. Narayana ReddyDirector, NIMHANS

Assistant Editor :N. Gopalakrishna

National Institute of Mental Health and Neuro SciencesP.B. No. 2900BANGALORE560 on, IndiaTelephone ; 42121, Telegrams: NIMHANS

1986

Printed at Lotus PrintersBangalore560 MO.

5

In the depths of the heavens themoon sails shedding splendourthat is a benediction. Below,on the troubled waters of lifemoves the mind of man, swan-like. Near-by is the heart-lotus, passion-laden and just blos-soming. Hidden in the wombof waters lies peace born ofharmony, to be realised by onewho has subdued passion.

6

Chairmen of Governing Body

'Dr.,Karan Sing.

z

Sri. Rabi Ray

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Previous

Present-

iirs..Mohsina Kidwal

Jagadambi Prasad Yadav

. ,

Sri. B. Shankarananda

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Vice-Chairrnen of Governing Body

Sri. A. K. Abdul Samad

Previous

Present

Dr. H. L. Minim Gowda

SriAT:Malitippe.

Sri. Ramakripboa Hegde

Dr. R. M. Varma

Directors of NIMHANS

Previous

Present

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Dr. G. N. Narayana Reddy

9

Dr. K. S. Man!

CONTENTS

The Significance of NIMHANS

From the Director's Desk

Departmental Reports

1. Psychiatry 1

2. Clinical Psychology 53. Neurology 124. Neurosurgery 175. Psychiatric Social Work 216. Neuroanaesthesia 267. Speech, Hearing & Language 298. Nursing 319. Physical Medicine & Rehabilitation 33

10., Neuroradiology 3511. Neurochemistry 3712. Neuropathology 3913. Microbiology 4314. Neurovirology 4515. Psychopharmacology 46 .16. Neurophsiology 4917. Biophysics 5318. Biostatistics 5719. Cytogenetics 6020. Central Animal Research Facility 6121. Library & Information Services 6322. Publications 6523. Medical Illustration & Audio Visual Aids 6624. Biomedical Engineering Section 6725. Engineering Section 6926. Ayurvedic Research 70

Faculty Members 74Statewise Distribution of Courses 77Prizes Awarded 78WHO Trainees 80Seminars/Symposia/Conferences held 81Publications of Staff 83Publications Brought out 93Donors 94

The Significance of NIMHANSDr. R. M. Varma, Professor Emeritus

Any sensitive person, taking a look at the world we live in today, will beoverwhelmed by three different feelings. There is an excitement over thephenomenal progress we have made in this world over the years. There is fear ofhuman destructiveness and what it will do to this world.There is sorrow over thepoverty that continues to grip large segments of world population today.

Advances in science have placed increasing knowledge and power in humanhands without a concurrent rise in insight, wisdom and value perception. Medicalsciences have been successful in continuing to eradicate diseases, but health,happiness and humanness are woefully lagging behind. While man istriumphantly brandishog his sword of external mastery, he is choking within dueto a loss of inner freedom.

The reason for the above predicament is not far to seek.in the development ofan individual and the society around him embedded in a large eco-system, thereare three fundamental processes at work. The first is an unfolding process of thehuman potential in each individual which is highly specific and unique. Thedevelopment of knowledge, intuition, values, skills and capabilities are of anenriching nature, lending diversity and variety in existence.

The second is a relating process part relating to another part or whole. Anautonomous part with a specificity and uniqueness relates to a heteronomouspart which is distinct and different, and both relate homcnomously to somethinglarger than both. For a conscious man relating to anything or anyone else, it isimportant to be actively aware of this homonomy. In its absence, the relationshipbecomes an exploiting one one gaining at the expense of the other.Awarenessof the larger dimension makes the relationship creative, which is mutuallyenriching.The quality of relating significantly affects human behaviour. A happyworld is one in which the relationship between man and nature, man and man,and man and God are sound.

The third process is the simultaneous and holographic perception of unity anddiversity that characterise everything.At a time when knowledge is advancing inparts, discretely and with focal precisions, the experience of unity and wholenessis essential for getting the full meaning and significance of the part underconsideration. If in all human endeavours the unfolding, relating andholographic processes are actively and consciously taken into account, theconfronting, conflicting and competing relationships will be changed intocomplementing creative relationships of men, societies and nations. Destruc-th...iess will be transformed into ennobling social action and excellence andhumanness will become mutually enhancing.

It is against this background that NIMHANS, Bangalore, India should beviewed. A multidisciplinary Institute in the frontier area of Mental Health and

i11

Neurosciences, has emerged in a multicultural country, which attained politicalfreedom in the wrIfe of two devastating world warsAndia is poised, for a boldplunge into modernity vibrant with values springing from her precious culture,wisdom and her own unique personality. She is already playing a pivotal role inthe international scene to prevent confrontations and threatened annihisation ofour planet. Every effort is being made towards the evolution of a ?odd economicorder of a mutually enriching kind, based primarily on the quality of humanresources replacing the present transaction based, protectionridden one whichis prone to promotion of exploitation and maintenance of poverty. India has aunique opportunity to succeed in all the above efforts as she is fortunate inhaving all the elements within her borders to test out this remarkable andexciting model of global importance. The NIMHANS model cf integration hasgiven the most valuable insights that go far beyond the field of health into thevery texture of nation building.

The following are the significant elements of the process of integration.

The Triple EventThe vision and elements of a new venture were already present from 1954.

But the elements were discrete, non-coherent and hence conflict-prone. Feb-ruary 14, 1975, ushering in NIMHANS, witnessed the phenomenal marshallingof a number of intejrative processes into a meaningful whole. The triple eventthat marked this historic occasion was itself significant. The first inaugurationwas the integrated Institute itself. The second was the inauguration of thecommunity psychiatric unit at Sukalawara extending a participating handoutwards into the community. The third was the inauguration of the project-consciousness a pioneering experiment looking inwards.

OrganisationThe departmental Institute of All India Institute of Mental Health of

Government of India was amalgamated with the Mental Hospital ofGovernment of Karnataka into the autonomous Institute, National Institute ofMental Health and Neuro Sciences with the participation of the BangaloreUniversity. The combined invnlvement of the three organisationsGovernmen:of India, Government of Karnataka and Bangalore University in the GoverningBody of the Institute, gave a quantum jump in administrative and academicfreedom for growth and development, which was unavailable in any otherautonomous or nonautonomous institute managed by a unifunc..ag agency.Not only did the centrestate difficulties instantly disappear, but e . relationshipturned into a mutually facilitating one which was amply proved by the Institute'sgrowth in.geometrical progression over the decade.

Community ParticipationIntroduction of modern technology particularly in a developing country with

resource constraints, often results in the growth of isolated "Ivory Tower"institutions. The benefits of the developing competence do not reach thecommunity nor do the community's problems reach the centres. The core ofthe mind of man, the core of the Institution that he makes, and the core of thecommunity of which he is a part should be in constant communication for theoverall character and quality of the endeavour. As early as 1970, a team of

ii 1,2

psychiatrist,. clinical psychologist, psychiatric social worker and psychiatricnurse, was sent to Mandya by this Institute to establish links with the community.This participating effort is now yielding-invaluable fruits. NIMHANS has theunique distinction of creating the first professorial chair in community psychiatryand is among the very few institutions in the world to do so. The Institute is nowtaking a lead in the implementation of the national mental health policy,throughout the country. The urban-rural integration is well on its way

ConsciousnessThere has always been communication gaps among science, humanism and

spirituality. An insight into the linkage of the above three is vital for anyworthwhile activity. This is a powerful motivation for the stimulation of thegrandeur and challenge of scientific temper, the ennobling perceptions andexpressions of humanness and the experiential transformations of the spiritualquest characterised by a sustained commitment to emergent values.It is with thisin mind that the first ever comprehensive project-consciousness was launchedalong with the other historic events. It is hoped that the invaluable insights of thepioneers of the East and the advancing frontiers of scientific knowledge from thepioneers of the West, together forming the main design of the project, will makeavailable simple techniques, not only to alleviate the suffering but also to unfoldthe human potential for leading a better life.

Service, Training & ResearchAnother significant integrative process visible in the Institute, is the priority

gradient established in service, training and research. At the dawn of India'sIndependence, a division of responsibilities came on the scene, probably as atemporary measure. The Central Government took on the responsibility ofpromoting teaching and research while theState Government shouldered theresponsibility of service. Though this contributed a lot in the beginning towardsdevelopment, the policy gradually produced grotesque distortions andanomalies in the approach of the professional to the sick. When researchassumes primacy the patient becomes an appendage. When this deterioratesfurther, the former becomes a vehicle for self-glorification and the latter becomesa dehumanised object. If this is to be avoided, a strong, efficient service baseshould be established first, in any institute of higher learning. Training pro-grammes should be geared to this, and the research activity should stem fromthis. Then, the training and research will show a worthwhileness and excellenceof a high order. The impact of NIMHANS on the society around, has been mainlydue to the strict adherence to this pattern of integration of services, training andresearch, in that order.

We are passing through an era of knowledge explosion where a widening gapis evident between knowledge and wisdom on one hand, and knowledge andaction on the other. The above integration will tend to close these gapssignificantly reducing the wastage of men and money and increasing the qualityof life. Knowledge is great, but it is auto-detonating if it excludes itself fromvalues.

Multidisciplinary ApproachThe central core of integration in this multidisciplinary postgraduate Institute,

is the grouping of the subjects that come under its purview. Specialisation is a

40;1- 1.3

boon. But compartmentalisation is vicious. Medical nemesis sets in when the twoare combined. If this is to be avoided, every specialist should have an activegeneral awareness.

Every symptom for which a patient comes for help, has physical, mental aridsocial components. The specialities perteining to the field of mental health andneuro sciences, covered by NIMHANS encompass all the three dimensions.Teams of interacting, specialists participate in understanding, investigating andtreating- patients at the out-patient and in-patient levels, so ,that a holisticapproach is fostered and nurtured. Therels a dynamic, live participation in eachcase, so that the full health dimension emerges in the individual, not onlyrelieving hirri of the distress, but also promoting him to be a participatingmember of the community.The same integrated pattern is followed in academicprogramming and examinations system.

In addition to the three dimensions, NIMHANS has also been providingspiritual inputs. It is significant to note that when WHO deliberated on addingspiritual dimension to the already existing definition of health (which comprisesthe physical, mental and social dimensions) in response to India's specificrequest, the first comprehensive seminar by WHO on spiritual dimension ofhealth, was held at NIMHANS.

Faculty of Mental Health and Neuro SciencesFrontier research needs jdnctional explorations between disciplines. In all the

universities, compartmental regulations prevent a student from doing adoctorate under two different guides from two different disciplines. NIMHANSwas able to pioneer the creation of a faculty of Mental Health and NeuroSciences in the Bangalore University, which enables, a student to obtain adoctorate degree in a frontier area. This is again, first of its kind in the history ofresearch. Bangalore University is the only university that has this faculty.

Cultural ContextModern health inputs, not integrated with culture will either become

fragmentary or face rejection. NIMHANS, from its very inception had a Divisionof Sanskrit to explore the cultural foundations from ancient original texts inSanskrit and regional languages and integrate them with several areas of mentalhealth and neuro sciences.

Tradition and ChangeIt is increasingly being realised that traditional systems of health, sprung from

the soil, have great contributions to make towards the health of a community.Ayurveda is one of the highly integrated systems that is in vogue. The first andthe only Ayurvedic Research Unit in the field of mental health along side themodern system of medicine, was established in this Institute in 1959. With theintegrated functioning of these 'systems in this multidisciplinary Institute, it ishoped that the true complementarity will be brought out, contributing towardsthe practice of holistic medicine.

Foundation in Basic SciencesAn integration is also evident among the basic science sections, diagnostic

sections and clinical sections, all geared towards the multidimensional approachto man in illness and health.

I . AI.

'VI_ -it

Usually in animal laboratories either drug trials are conducted or new techniquesof intervention are tried out. But in this Institute, special integrative elements areincorporated. Comparative sciences are brought in, to lend an evolutiJnaryperspective. In addition to tracing and verifying the physical, physiological andchemical functions of the human system in animals, enquiries are extended topsychological and sociological functions.

The FutureThus, NIMHANS is a child of integration, of the body, life, mind and spirit of

man born to serve, to learn and to explore. A decade has already demonstratedthe foundations of integral health and integral living. This is Vim-Hans' yourswan a little unfolding- relating-holographic being. This model, perhapsshows the pattern for a national integration of our country with many culturesand traditions emerging on the international horizon to play a leading role topilot the world through its present chaos and crisis.

May the 'swan' herald an abiding peace within individuals and among nations.

153. v

,-;

From the Director's Desk

The National Institute of Mental Health andNeuro Sciences (NIMI-LANS) wasinaugurated on 14th February 1975 by the then Union Minister for Health andFamily Welfare, Dr. Karan Singh. After a long effort .of seven years, this waspossible because of his firm conviction that the futureof the Institute dependedon the integration of State Mntal Hospital with the All India Institute of MentalHealth. In the process, a new venture of partnership between the State andCentral Governments, in the management and sharing of funds was initiated forthe first time in the country. A decade has passed since then. As we enter into thesecond decade, it seems appropriate to look back, assess the presentorganisational and administrative set up, define our current activities, outline thedevelopments taking place and look tentatively at the future.

Organisation and AdnlirdstrationEstablishment of the autonomous body, registered under the SocietiesRegistration Act has proved definitely an advantageous and fruitful step. Thefunctioning of the GoverningBody, with the UnionMinister of Health and FamilyWelfare as Chairman and Minister of Health and Family Welfare, Karnataka asVice-Chairman has been effective and result-oriented. The decisions are madeand implemented on the deliberations and recommendations of the statutorybodies, namely the Finance Committee, Academic Committee, Building &Works Committee. and Rehabilitation Committee. The Institute has made adefinite and very significantgrowth, with greater efficiency iri the fields of service,manpower development and research activities. It is with pride and greathappiness we can perceive that the dreams of founders of this Institute are beingfulfilled. Almost all the objectives are on the anvil. Many have started givingresults and some are initiated. The importance of mental health and neurosciences is perceptibly felt in the country. The Institute is recognised as foremostin this field. Advanced services, training programmes and research activities aredeveloped in the areas of biological, behavioural and basic sciences, in relationto brainmind axis.

FundsThe institute is tunded both by the Union and Karnataka State C:vernmentsin the pioportion of 75%/25% under plan and 45 %/55% under non-planrespectively. The other resources are various research funding agencies likeICMR, DST, UGC, CSIR, international agencies like WHO, UNICEF, donationsand internal receipts.

We are particularly grateful to the Mysore Sales International Ltd., Bangalorefor theldonation of Rs. 70 lakhs towards equipment and research.

16

340320300

260

220

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(r)

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180-

140

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20-

FUNDS FROM GOVERNMENT

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75-76 76-77 i7-78 i8-79 iatio 80-81 81-82 82-83 83-84 84-85YEAR

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75- 6 77 78 79 80 81 82 83 84 85YEAR

New StaffIn keeping with the needs and development of the Institute to achieve the

intended oblectives, active steps are taken to create and fill up a number of posts.We did find and are still finding d.fficult to fill up some of the posts in the field ofbasic sciences. The mode of recruitment has been kept flexible, although firstpreference is by open advertisement. The other modes of recruitment aredeputation from Government or other agencies, contract 'appointments and

17

visiting professors. The growth of the staff strength is reflected in the followingdiagram :

1000

900

800

700

600

500

400tn

300

200

100

553 5-=-67

491

STAFF

715

661

9942 53

860 81A807

7576 76-77 77-7818-79 7980 80-81 81-82 82-83 8j-84 84-85YEAR

Manpower DevelopmentAll efforts are made to maintain a high standard of teaching. The courses

started earlier are :1. MD. Psychiatry2. D.M. Neurology3. M.Ch. Neurosurgery4. M.Phil. Clin. Psychology5. MPhil. Psych. Social Work6. D.P.M. Psychiatry7. D.P.N. Psych. Nursing8. Ph.D. in Clinical Psychology.

The following new courses have been, introduced:. 1. MPhil. Neurophysiology

2. PhD. in Neurophysiology3. PhD. in M.H. & N.Sc.4. Diploma in Neuro Nursing (DNN)

The following are the new courses approved to be started during 1986 :1. M.Phil. Biophysics2. M.Sc. in Psychiatric Nursing.

s. iii

18

Iri addition tOthese courses, postgraduate students from Medical Colleges andother institutions, from Karnataka and other Institutions are regularly posted fortraining:

Development of DepartmentsDuring the decade, the existing 'departments are expanded with increasing

number of faculty and other staff. Advanced, sophisticated and latestequipments were provided and constant updating is assured. Service facilitieshave been extended beyond the confines of the Institute into the rural areas.

-Constant and regular clinical services and training programmes are organised inrural areas. This opportunity is made use of to train the trainees to serve in therural areas .and also to develop health service research programmes tounderstand epidemiological problems, local needs and to evolve simpleremedies. The institute is open to the public not only to get services but also toinvolve themselves in various activities, in particular in rehabilitation activitiesand creating better awareness.

The new departments added during the decade are :Neurophysiology

2. Psycho-pharmacology3. Microbiology4. Neuro Virology5. Cytogenetics6. Speeth, Hearing & Language7. Rehabilitation & Physical Medicine8. Publications9. Mental Health Education and

10. Epidemiology (to be started)

Addition of new departments has given the expected impetus to develop themultidisciplinary research activities. Some of these departments still need to beequipped and scientists to be recruited.

ConstructionLack of space has been a constant constraint to provide better service facilities

and to house laboratories.The demand for quarters for the faculty and other staffcontinues to exist. Efforts are made to improve the situation in all these areas.Anew comprehensive out-patient block will be ready soon.This has been plannedat a cost of about Rs. 135 lakhs, with all outdoor facilities and emergencyservices.

The wing of paediatric neurology & neurosurgery with 28 beds and additionalpsychiatric special wards with 70 beds are added to the inpatient services.Further the rehabilitation services are being expanded with an additional wingand inpatient bed facilities for rehabilitation of neurologically disabled. Intenseefforts are put into increase the available residential quarters. At the start we hadonly 107 quarters for faculty. This has been increased to 137 during the decade.A new hostel for postgraduates and staff' members has, been added.

Being an academic and research institute, the existing library and informationservice facilities are found to be very inadequate. Plans are already drawn up fora new library & information service block at an approximate cost of Rs. 65 lakhs.It is also proposed to construct a ladies hostel, an auditorium in addition to new

,iv

residential facilities in a newly acquired land of about 17 acres, atI3yrasandraadjacent to ,the campus:

Collaboration with ADAMHA, U.S.A.The addition of basic facilities has certainly boosted up the research activities.

The attitude and the outlook of the faculty has changed for the better scientificwork. The series of symposia/seminarOyorkshops conducted regularly, hasmade the staff and students up-todate The scientific temper is appreciated byleading scientists from abroad. This has resulted in an agreement betweenADAMHA and NIMHANS. Under this agreement, the exchange of scientists andthe dissemination of advanced scientific knowledge through seminars andpublications are found to be very useful. The collaborative research projects tostudy the differences between the East and West are under progress, particularlyin the fields of affective disorders and drug abuse and alcoholism.

Advanced Centre fdr Research on Community Mental HealthAs a recognised of the work carried out in the field of community mental

health, an advanced centre in this area is sanctioned by ICMR for five years. Themain objectives of this centre are,. (1) to develop and evaluate suitable models forproviSion of basic mental health care (2) to undertake epidemiological,phenomenological and intervention research (3) to develop and standardiseinstruments and tools for research purposes relevant to Indian situation.

Implementation of National Mental Health ProgrammeThe present mental health services are catering only to about 10-15% of the

suffering population of the country. Realising this, in 1975 the communitymental health unit was started at NIMHANS. The Mahabodhi Society joined usin this venture,, and the Sakalawara unit was started. Later this pemises of 12acres with hospital and residential facilities was purchased from Mahabodhi

20

Society. Regular training programme for primary-health centre doctors and-health workers was started in 1982. It is in the same year the Government ofIndia approved the National Mental Health Programme with the objectives ofthe foreseeable future-particularly to the mostsvulnerable and under-privilegedsector of the population. The main approach to achieve this is by integratingmental health care with primary health care. After developing models and tryingthis training programme in different centres, regular programme to train thehealth workers and the primary health centre doctors has been evolved. Theregular training of PHC doctors and health workers has been undertaken since1982 ,for. Karnataka State. The States of Uttar Pradesh, Madhy Pradesh,Haryana, Pondicherry have been sensitized and training of trainers toimplement national mental health programme has been done by involving theadministrators and the appropriate individuals and.plans have been worked outto implement this programme in the above States.

LinkagesThe common lacunae, in the institutions of par excellence in scientific research

activities is the exposure to the field at grass root level. During the past fouryears, the faculty and other staff have started interacting and working in ruralareas. This has helped them to understand the rural problems and to evolvedifferent approaches, in-the field of health-services, and to fall in line With thenational policies. A good cooperation has been established between NIMHANSand Karnataka State. Departments. in particular, the Health & Family WelfareDepartment, Social Welfare Department and Education Department. Verybroad based links are established between different departments of the IndianInstitute of Science, Bangalore and NIMHANS. A number of scientistsparticularly from departments of biochemistry, molecular biology, physics,instrumentation etc. are interacting and working with the scientists ofNIMHANS.

Community ParticipationSuccess of any service facility depends on the involvement of the community.

It is much more so in the field of mental and neurological sevices. Activeparticipation of FRIENDS of NIMPIANS, a voluntary organisation, in the daytoday programmes of the Institute, rehabilitating the discharged patients in thefamily and attempts in changing the attitudes of the society, is highlycommendable. The industrialists, and business people are guiding andsupporting us in introducing and sustaining various vocations in therehabilitation centre. The philanthropists have come forward in constructingrelatives rest house for those who come from long distances. The voluntaryorganisations like Rotary Clubs, Lions Clubs and local bodies have beenconstantly involved in organising, conducting and providing free drugs to theneedy in our extension services in rural areas.The monthly extension services atKanakapura, Maddur, Madhugiri and Gowribidanur, located at a distance of 65kms to 120 kms from Bangalore have been serving many needy poor patients attheir doorsteps.

Deemed UniversityThe institute has grown in stature. The fullfledged, advanced service facilities

should be utilised for manpower development and development of researchactivities ,elsvant to Indian situation. The latest developments in the fields of

VI 21

mental healthand neuro sciences are most exciting. Therefore, it is not enougato simply train the post-graduates just to practice a speciality or undertakeresearch iri a specific area. They should be exposed to wide variety of advancesoccurring and ;ithooled in the academic discipline of multidisciplinary approach.To achieve this, the Governing body has decided to make this Institute a DeemedUniVersity: TheG overnment of Kafnataka, the Government of India and theUniversity Cants CoMmission have been- approached in this 'regard. We hopethe deemed university status will be.granted.very soon.

AwardsIt is a pleasure to place on record that several faculty members have been

conferred with awards for their distinguished contributions in their fields ofspecialisation.

Dr. T. Desiraju, Professor and Head, Department of Neurophysiology hasbeen bestowed with General Bhatia Memorial Award of the Association ofPhysiologists and Pharmacologists of Indian in 1980; the Shanthi SwarupBhatnagar Award of the Medical Council of Ir. aia in 1980; B. C. Roy NationalAward of the Medical Council of India in 1982, and the Basanti Devi AmirchandPrize of the Indian Council of Medical Research in 1985.

Dr. M. Gourie Devi, Professor and Head, Department of Neurology wasconferred "Lt. Col. K. N. Waghraj Memorial Gold Medal Oration" at the Collegeof General Practitioners, Hyderabad, Andhra Pradesh in 1978; honoured as"Distinguished Scientist" at the Andhra Medical College, Visakhapatnam,Andhra Pradesh in 1982 and awarded "Dr: P. Gurumurth Memorial Oration"Commemoration Gold Medal, Indian Medical Association, Vishakapatnam,-Andhra Pradesh in 1985.

FutureThe important future action is to consolidate the gains achieved so far. The

size of the institute should be optimum to utilise and nurture all the availablestrength. The excellent basic research knowledge should flow into the field forthe benefit of human mankind.

G. N. NARAYANA REDDYDirector

22vii

Psytthiatry

The Department of Psychiatry, one of theoldest and largest in the country, started withjust two faculty members in the then All IndiaInstitute of Mental Health, is.today one of themajor components of NIMHANS. Its range ofactivity has extended beyond the walls of the

-hospital into the community ina variety ofways, some of which are pioneering and hasoccurred in the past one decade.

MANPOWER DEVELOPMENT

The Department is the largest supplier oftrained, psychiatrists in the ,country. So far,the department has produced over 300DPMs and nearly 100 MDs in psychiatry,nearly half of this in the past one decade.

The training programme is, carried out atthe unit level, departmental level and alsointerdepartmental level: Training is alsoimparted to workers of other departments ofthe Institute, undergraduate Sand postgra-duate trainees, other medical colleges andinstitutions.

One of the highlights of the decade is theintroduction of screening tect in the selectionprocess for DPM and MD courses, which wasintroduced in 1977. In 1982, a separatescreening test was introduced for thoseapplying for MD course after DPM.

Another highlight is theJntroduction ofsystematic, supervised training in psychothe-rapy. The group of supervisors are in theprocess of evolving -a model. of psychothe-rapy, which will be easy to teach,,practice andbest suited to the local culture.

HOSPITAL SERVICESThe decade saw several innovative mea-

sures in the services of the hospital, viz.,

improvement in the living conditions of in-patients, streamlining of the outpatientservices a centralised service for modifiedelectroconvulsive therapy, setting up ofintensive care facilities for the inpatients withacute physical ailments, and the new specialwards block.

The walk-inclinic introduced in 1978 has,facilitated better patient care by improvingthe diagnostic screening of the patient. Thefollow up rate has gone up 1:ly almost 30')percent in the.past 10 years. The long, stay,patient population has decreased to less than100, probably the lowest among the mentalhospitals in the country. Sorhe of these longstay patients live in Garden Home built byvoluntary agencies inside the hospitalgarden thus decreasing the ill effects of theinstitutiOnalisation to a considerable extent.

The average hospital stay has decreasedfrom 80 days to 50 days in this ten years andthe certified casa admissions are among thelowest in the country.

SPECIAL SERVICESThe most significant aspect of the depart-

ment is its special services, pioneering innature. Important among them are :

(i) Family Psychiatric Centre, (ii) Child andAdolescent Psychiatry Unit, (iii) MentalRetardation Clinic, (iv) Rehabilitation Unit,(v) Community Mental Health Unit and(vi) Neuro-psychiatric extension clinics atfive centres.

Fanilly Psychiatric CentreRecognising the importance of multi-

dimensional approach, both in understand-ing the etiology and management of mental

23

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illness, family psychiatry was ,given duerecognition as early as 1968 whentemporary wards were stateed on anexperimental basis. At the beginning themajor thrust was to treat the index pati.ntinthe presence of his/her family members.Later, this lead into taking the family into thehospital . for treating various problemsarising out of family situation. A familyAssessment Format, a family interventionProgramme, quantification of groupinteraction, measurement of family typesare some of the notable achievements ofthe centre. The present permanent structurewas commissioned in 1976.

Child and Adolescent Psychiatry UnitSeparate services for children and auole-

scents existing in the form of child guidanceclinic, was established as an independentunit in 1976, offering treatment to 20children and 10 family units as inpatientsand provides outpatient services thrice aweek, for new patients.

A School Mental Health Programme forsensitising teachers in early detection ofmental health programme among childrenand intervention at their level throughimparting training in counselling techniquesare among the more notable achievementsof the'Unit.

The Unit on an average handles about700 new cases, 2000 follow ups and admits200 cases a year. With a systematic pro-gramme of training the personnel fromvarious disciplines the Unit has the potentialof becoming a National Centre for highertraining in Child Psychiatry.

Mental Retardation ClinkThe weekly clinic offers screening facilities

along with group counselling sessions toparents of retarded children. A majorachievement of the clinic is, the initiation ofSelf Help Groups, developing models ofmanagement for propagation throughoutthe cuntry. Families/parents with the

handicapped, of similar problems areadmitted for 2-3 weeks to provide training tothe parents in Self Help skills.

Community Mental Health UnitThe Unit started functioning in 1975 with

the objective of knowing the prevalencerates and nature of mental disorders in thecommunity and to design and developmodels of mental health care in thecommunity, and to develop a trainingprogramme in mental health to primaryhealth care workers and medical officers.

A field practice area, consisting of 150villages covering a population of 76,000has been developed around the Rural Men-tal Health Centre at Sakalawara, nearBangalore.

The experience with two pilot projects oftraining PHC doctors and health workers,lead to the starting of a two week trainingprogramme in mental health care to primary'health care personnel with the active co-operation of the Department of Health andFamily Welfare, Government of Karnataka.Twelve to sixteen health workers and 5 to 6medical officers undergo this manner oftraining every month. Based on thisexperience, the unit has organised trainingcourses and workshops for mental healthprofessionals and health administratorsfrom various states in the country. A districtlevel model to implement the NationalMental Health Programme is beingundertaken in Bellary district of Karnataka.

Considering the importance of the workand contributions of the unit in extending themental health care at the primary health carelevel, the Indian Council of Medical Researchhas sanctioned an Advanced ResearchCentre in Community Mental Health atSakalawara.

The unit has brought out manuals inrental health care for medical officers andhealth workers. The mental healthprofessionals have been trained from the

24

states of AP, MP, UP, Haryana, Punjab, HP,Maharashtra, Pondicherry and Karnataka.These states have been sensitised byconducting workshops for .planners andtraining of primary health care personnel hasbeen undertaken in many of these states.

Mental Health Centreat K. C. General Hospital

The centre offers mainly consultatico-liai-son psychiatry. The centre undertook thepioneering work of training batches of urbangeneral practitioners in mental health care.This model was successfully tested as anICMR multicentre project.

RESEARCHA major step in goal directed, systematic

research has been the formation of researchgroups among fact qty members. Areas forfurther in-depth study have been identifiedby the groups, importance br lg given tocontinuity in various research studies:

The areas of research in which the depart-ment is engaged are:

1. Psychiatric Epidemiology & Comm-unity Mental Health.

2. Psychiatric phenomenology3. Pharmacological and other modes of

therapy4. Biological aspects of Psychiatry5. Family Psychiatry6. Child & Adolescent Psychiatry7. Mental Retardation8. Community Psychiatry9. Alcoholism & Drug Dependence

10. Psychiatric Rehabilitation.11. Geriatric Psychiatry.

The Department has been involved inmany intercentre collaborative researchprojects, funded or otherwise. The visit ofADAMHA group in 1984, 1985 and thesymposia held during their visit has givenfurther Impetus to the research efforts of thedepartment.

Among the notable research projects ofthe department, the ICMR collaborativestudy on severe mental morbidity, theevaluation of the training programme forPFIC personnel, the ICMR collaborativestudy on training in mental health care forgeneral medical practitioners deservespecial mention.

FUTURE PLANS

In the area of phenomenology, clinicalprofile of various psychiatric disorders arebeing systematically looked into. Specificsyndromes are being investigated in-depthand important psycho-pathological pheno-mena are being explored. An attempt isbeing made to study the long-term courseand outcome of certain disorders.

In the therapeutic area, an ICMR studywas done on the role of lithium carbc-mate inaffective disorders including its efficacy andbiochemistry. Other drugs bring studied arecarbamazepine in psychiatric disorders,cloridine in opiate withdrawal states, andamphetamine in negative schizophrenia.

Even the routine drug trials have takennew dimension in the launching ofmulticentre collaborative study of two newdrugs, centibutindole in schizophrenia andOlprazolam for anxiety and depressivedisorders.

Electroconvulsive therapy was investi-gated in a double blind, prospective,randomised study in endogenous depres-sives and was found to produce quicker reliefcompared to Imipramine. In another studyECT was shown to be superior toneuroleptics in schizophrenia.

In keeping with the general trend theworld-over in biological aspects ofpsychiatry, the department in closecollaboration with other departments of theInstitute has launched several importantstudies like biological correlates ofmovement disorders, serum and CSF en-zyme levels in psychotic states, biological

3. 25

markers in affective Lid schizophrenicdisorders.

Apart from standardising various familyintervention strategies in psychiatricparticularly schizophrenia, day hospital/ careevaluation, work-performance evaluationand employability of schizophrenics andmentally handicapped individuals are beingcarried out.

In the area of child psychiatry, an ICMRcollaborative study on pattern of child and

adolescent psychiatric disorders 'was com-pleted. In mental retardation, large part ofcompleted work deals with metabolite,cytogenetic studies apart from epidemio-logical, clinical-and seti;help group studies.

In the area of alcoholiyin and drug abuse,research is foCqssed oribiological correlates-of alcoholism, and- 'alcoholic withdrawalstates,= incidence and prevalence studies inselected por ,:ation, 4-5 year follow up oftreated alcoholics and treatment outcome.

Mental health care at the doorstep

426

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Clinical Psychology

The Department of Clinical Psychology,earlier known as the Department ofPsychology andHurnan Relations, came intobeing with,the founding of the erstwhile AllIndia Institute of Mental Health in 1954.From the very beginning the aims andobjectives of the department have been .(i)imparting postgraduate professionaltraining in clinical psychology; (ii) providingpsycholOgical services diagnostic as wellas therapeutic to the public; (iii) conductingresearch in the field of clinical psychology &(iv) advising other agencies --Governments,Universities and Institutions on theorganisation of clinical psychologicalservices, manpower development andresearch.


The department offers training in clinicalpsychology at two levels for scholars whohave their 'Master's degree in psychology.The first is a two year postgraduateprogramme. This was earlier known as theDiploma in Medical (Clinical) Psychology.(DMP) and later in 1960, it was designated asDiploma In.Medical and Social Psychology(DM & SP). In 1978, this programme wasredesignated as MPhil in Medical and SocialPsychology (M & SP). The changingnomenclature signifies shift in emphasisgiven in the training programmes as also tothe continuing efforts for curriculumdevelopment with the objective of providingclinical psychologists with a training relevantto the sociocultural realities of a developingcountry. From the beginning there is a provi-sion to train 12 candidates per year. TillMarch 1985, 267 candidates have qualifiedfrom the department.

Efforts at curriculum development havebeen continued. In 1979 a NationalWorkshop supported by the WHO was heldat NIMHANS to review the postgraduatetraining programmes in Clinical Psychologyand assess their rele-vance to the nationalrequirements. As a result, considerablechanges were introduced in the trainingprogramme in 1982. These have beenmonitored, evaluated and on furthermodification and recasting, new curricula arebeing implemented from September 1985.

A three year doctoral degree programmein Clinical Psychology, was initiated in1967/68. Initially there was a provision for .

registering two candidates every year. Since1982, the annual intake has been increasedto 4. So far 22 candidates have obtainedtheir PhD degree in Clinical Psychology; 3candidates are awaiting their-results while12 scholars are pursuing their programme.

Till the mid seventies, the department of-fered facilities and guidance to PhD.scholars in Psychology from the Arts Facultyof the Bangalore University. This practicewas discontinued since the establishment ofa separate psychology department in theArts faculty. The Department offers facilitiesfor a PhD. degree through the mental health& neuro sciences faculty. Through theseProgrammes, 13 scholars have obtainedtheir PhD; 2 are awaiting results andanother 3 are currently engaged in theirdoctoral work.

Besides its major role in the training of cli-nical psychologists the department is en-gaged in providing training in psychology topsychiatrists, psychiatric social workers, psy-chiatric nurses and such others. Developing

Zn

programmes and curriculum for the trainingof these professional groups is in operationsince 1982. With the introduction ofextensive training in psychodiagnostics,therapeutics, and psychopathology for theMD programme in psychiatry and making ita part of the final theory examination of theMD degree a major change has been intro-duced in the training of psychiatrists.

PsychodiagnosticsPsycho.iiagnostics had been and conti-

nues to be an important area in the trainingprogrammes. In the earlier years the stresswas on its contribution towards diagnosisand building of psychopathology. Thecurrent emphasis is on objective measureswith emphasis on their utility as tools for re-search; quantification and diagnosis. As apart of clinical services the demand forpsychodiagnostic services has been on theincrease.

Research interest on diagnostic tools isreflected by the fact that 80 MPhil disserta-tions and 20 doctoral theses have focussedtheir attention on utility of tools andattempted their adaptations and standardisa-tion. The earlier focus on test constructionper se had not been extensive. In the lastthree years this has been identified as athrust area and work is in progress indeveloping tests of organic brain dysfunc-tions; a short version of security-insecurityscale measurement of self-concept; deve-lopment of a scale for measuring stressful lifeevents; coping strategies and social supportsystems. The development of socio-cui-turally relevant psychometric tools isenvisaged for the next decade.

Psychosocial AspectsThe inception of the department being in

the mid fifties, there had not been deepinvolvement in the psychoanalytical thoughtand intrapsychic theories. Interest had beenmanifest in studying interpersonal factors aswell as studying psychosocial and socio-

cultural factors influencing mental healthand illness.

This is emphasised in the training pro-grammes with reference to the socioculturalfactors of relevance in the Indian setting.

In the initial years, one of the major areasof research work was on suicide and para-suicide. Later, work has been carried out inareas like self-perception; self-ideal dis-crepancy; self-esteem; self-alienation; socialidentity; interpersonal relationships; locus ofcontrol; social competence; congnitive dis-tortion; empathy; personality and adjust-ment aspects.

Since 1982, another major area of thrustthat has been identified is that of stress,coping, social-supports and adaptationwithin the framework of socio-technicalchange. Four doctoral scholars are currentlyworking in this area. During the next decadeit is planned to continue work in this area andstrengthen research in understandingpsychosocial factors in the promotion ofhealth and human development.

Yet another area of interest is that ofassessing the orientation and attitudetowards various aspects of mental health andiitless in different segments of population inthe community with the aim of developingintervention strategies and launching publiceducation programme. Two theses effortsare currently being pursued in this area.

Psychological TherapiesFrom the time the postgraduate training

programme in clinical psychology wasstarted, a paper on psychotherapy andcounselling had been a part of the theoryexamination. The trainees were encouragedto take up cases for psychotherapy undersupervision. This emphasis was streamlinedin 1976 by making submissions of psycho-therapeutic recoi ds a part of the coursework. The cases taken are predominantlyfrom the neurotic groups. The mostcommonly used techniques of psycho-

28

therapy are, supportive psychotherapy;rational emotive therapy; family therapy andmarital counselling. Therapy with indivi-duals with alcohol and drug dependence andfamily therapy has also been given im-portance.

During the next decade it is proposed tofocus attention on developing models ofpsychotherapy which are more meaningfulto the uneducated and less sophisticatedpopulation of the country. It is also intendedto further fortify the supervised training inpsychotherapy for postgraduates undertraining. The emphasis is to be on crisisintervention; supportive psychotherapy;family therapy; group therapy and rationaleemotive/cognitive therapies. As an initialstep in this direction, work on a doctoralthesis in this. area has been started.

Behaviour Modification andBiofeedback

The department started utilising beha-viour therapy as a mode of intervention sincethe late sixties. During the last decade and ahalf, the demand for behaviour therapy andbiofeedback services has been steadilyincreasing. Mainly, clients with various typesof neuroses; those with problems of alcohol/drug addiction; stress related disorders;sexual dysfunction and deviations areexamined. Therapeutic services areprovided to both adults and children. In thewhole country, this unit happens to be theonly centre which is fullfledged and active inproviding services, training personnel andcarrying out r search. Over the last 15 yearsa little more than 3,000 clients have beenexamined and treated in the unit.The clinicalrecords of these patients provide a richresearch data bank.

To provide continuing professionaleducation as well as to orient psychologiststrained during the sixties or earlier, thedepartment conducts continuing educationprogramme in behaviour modification andbiofeedback. The first such programme was

conducted in 1977. Since 1982, this month-long intensive programme for small groupsof 6 8 professional workers has become apopular and much sought after ar.nual fea-ture.

In addition to providing intensive trainingto psychology postgraduates, training is alsoprovided to psychiatrists, under training atNIMHANS as well as those coming fromseveral other institutions.

During the initial years of the next decade,it is planned to expand behaviour therapyservices by establishing separate sections forchildren; for those who need deaddiction; forthose with sexual disorders and devianceand in particular to develop models forextending behaviour therapy services in thecommunity. In the second phase, it isproposed to introduce behaviour therapyservices to stress related disorders; mainly inthe area of behavioural medicine andpsychoprophylaxis.

Child Mental Health and MentalRetardation

Training in child mental health formed apart of the training of the clinical psycholo-gists from the mid fifties. Initially the em-phasis was on the assessment of intelligenceand diagnosis. This has now broadened toinclude diagnostic assessment; building upof psychopathology as well as providingintervention by way of sensory motortraining; play therapy; supportive/individualpsychotherapy and behavioural counselling.Since 1980 research interest in this area hasdeveloped. One doctoral thesis has beencompleted while three on hysteria,scholastic backwardness and disorders ofconduct and emotion are in progress. Theresearch interest also covers the area ofdeveloping tests and test norms for use withchildren in the Indian setting.

Since 1984, a therapeutic group for moth-ers of emotionally disturbed children hasbeen started. Special services like the schoolmental health programme are also offered.

Over the next 10 years, the researachfocus would be on the standardisation ofdevelopmental schedules; cognitive testsand personality tests deemed necessary forcarrying out systematic research in the areaof developmental disabilities and childpsychopathology. It would also extend to thearea of studying the phenomenology andpsychopathology of non-psychotic func-tional disorders and scholastic backward-ness. For the purpose of intervention, modelsare being evolved for remediation work withthe scholastically backward; therapeuticintervention for children with nonpsychoticdisorders and; group work and counsellingwith the parents of the emotionally disturbedchildren.

Mental Retardation

Since 1976, with the establishment of anexclusive clinic at the NIMHANS forindividuals with mental handicap thedepartment of clinical psychology has beeninvolved in the comprehensive assessmentof the mentally retarded persons;formulation of the clinical/social diagnosis;planning intervention and habilitation.Group counselling is provided for theparents of the handicapped persons. Sincethe beginning of 1985, 6 residential unitshave been kept apart for training the parentsof the mentally handicapped children so thatthey can continue training their handicappedchild at home.

With the recent announcement of theInstitute about its long term policy toorganise comprehensive services for all withdevelopmental disabilities and separate itinto an independent department an exten-sive change in orientation and working isbeing planned.

NeuropsychologyNeuropsychology was introduced as a

speciality subject in the DM &SP pro-gramme in 1973-74. This emphasised thebiological foundations of behaviour. For thepurposes of patient evaluation a clinical

approach was preferred to psychometricmethods. Intensive efforts were made since1976 to develop expertise in clinical neuro-psychology and the expertise for a compre-hensive clinical neuropsychological exami-nation was evolved by 1978. The utility anddemand for this service component becomesapparent with a look at the referral rate ofpatients which has increased from about 250per year to 1,236 during 1984 85.Simultaneously, the cases being referred areno longer from the departments of neuro-surgery and neurology but are alsoirorn thedepartment of psychiatry and specialityclinics like the head-injury clinic and thespina bifida clinic.

Efforts to develop an experimentalneuropsychology laboralof9 materialised in1981 and since then a laboratory of interna-tional standards is in the process of beingestablished Much of this has taken shapeand the same at present has facilities andexpertise for electrophysiological recordingand detailed computer analysis of signalsand data. The major areas of interest arecognitive psychophysiological research inschizophrenia and frontal lobe functions.The laboratory has completed two prelimi-nary studies on schizophrenia and currentlyin collaboration with the department ofpsychiatry, has taken up a three year follow-up study of schizophrenia. Other areas ofresearch interest are psychological andpsychophysiological deficits in head injuryamong adults and children and alcoholism.

Since 1983, an Information processinglaboratory is also being established. Thework has already commenced in the area ofinformation processing deficits in post trau-matic syndrome as well as other organic,conditions involving brain pathology. Acognitive retraining programme, with em-phasis on attention and memory training,developed in this laboratory is beingsuccessfully used in patients with head injury

especially those with post traumaticsequelae. During 1983-84, 12 patients were

{ <8 30

provided with the retraining programme ona pilot and experimental basis. It is proposedto extend this as a routine service facility. Abattery of information processing tests usefulin the diagnosis of post-traumatic syndromehas also been developed.

This is the only centre in the country withan integrated clinical and experimentalneuropsychology unit of excellence. The unithas been able to project neuropsychology asan important research area in the field ofneurobiblogy at the national level: So far onescholar has been awarded PhD. In this areawhile two others have completed their workand submitted their theses. Three Ph.D., twoMD and two M.Phil students are working inthis area.

The existing research interests will be,pursued in the coming years with. specificobject of developing early diagnostic mark-ers; outcome predictors and indicators, andalso to gain insights in psychopathology.Effects of environmental inputs, develop-mental problems and nutrition on neuropsy-chological development in individuals, asassessed by psychophysiological and infor-mation processing methods will be of majorresearch interest of this unit. Understandingdeficits and recovery of these neuropsycho-lcgical functions with respect to basicfunctional levels already reached, in case abrain. pathology develops in any of them, willbe another important aspect of this researchprogramme.

Community PsychologyThe NIMHANS accepted the community

mental' health methodology from the midseventies. From the very beginning thedepartment of clinical psychology hasprovided routine diagnostic and therapeuticservices to the urban community through theservices established by the CommunityMental Health unit in a general hospitalsetting. A schoc' health programme wasenvisaged and initiated in 1976. Schoolteachers were trained to identify children

with emotional and behavioural problemsand give them on the spot assistancewherever possible, or refer the children toappropriate clinical agencies.

Since 1982, in line with the philosophy ofthe National Mental Health Programme, thedepartment has focussed more attention onthe rural community. Preparation of mentalhealth manuals for workers at various levelsin the health delivery system; monitoringand evaluating training programmes givenby the community mental health unit to findout the level of their effectiveness; enhancingpublic cooperation through increased aware-ness of problems of mental health and illnessand trying out the feasibility and efficacy ofbehaviour modification techniques in thecommunity have been the areas of majorthrust. Since early 1985, efforts are 'underway to provide training for the parents of thementally handicapped individuals so as toequip them to care for their handicappedchild at home.

In addition to the increasing of manpowerthrough adequate training programmes forperipheral health workers at all levels, the de-partment is also interested in the formulationof training programmes in mental health de-livery through non-professionals who are out-side the health care set up. One such identi-fied group has been the Anganwadi workers.

Work experience in this area has pointedout the need and provided the know-how toincrease the training inputs in CommunityPsychology in the course curriculum of thepostgraduate training programmes in clini-cal psychology.

ParapsychologyThe work in the area of clinical para-

psychology was initiated with a work carriedout for one of the doctoral theses in the eaiiyseventies. So far nearly 250 individuals whoclaimed that they remembered theirprevious lives have been investigated andtheir claims and characteristics analysed. Apreliminary enquiry into Neat Death,

t 9

Psychological assessment of a child

s, .'

Psychological testing

3 2

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Experience phenomena and claims of someothers who reported paranormal abilitiessuch as pre-cognition; pre-cognitive dreamsand paranormal healing have also beentaken up for study.

The work carried out since 1980 hasmostly been on the basis of individual casestudies. It is intended to extend the work inthe coming years with greater methodologi-cal refinement and rigour.

RehabilitationThe involvement of the department of

clinical psychology, in the area of rehabilita-tion on a regular basis has been one of recentdevelopments. The clinical psychology de-partment has been engaged in the com-prehensive assessment of the patient toenable his early rehabilitation in social andoccupational spheres. Utilisation of the beha-vioural modification techniques, especiallythe token economy programmes, has been amajor involvement. Since 1982, 72 indivi-duals have been taken up in this programmewhile 32 are currently on treatment. Duringthe seventh plan period it is planned to

extend the area of work to the field of neuro-rehabilitation. The work in this area so farhas a predominent clinical emphasis. It isplanned to take up research studies in thisregard in future.

Study of ancient Indian texts and conductof theoretical research to find out thepossibility of identifying meaningful materialfor understanding problems of mental healthand mental illness in the Indian context hasbeen an area of interest in the department.This has an all 'pervasive nature as everyarea of research interest of the departmentcan be provided with relevant material fromthe ancient Indian texts.

The above account of the activities of theDepartment of Clinical Psychology has beendivided into several sections for the purposesof providing a birds eye view of the activitiesthat are ongoing in the department. To adiscerning reader it would be obvious that inspite of the above categorisation there is ageneral communality of interest which isunderlying the activities of the variousgroups within the department.

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Group Counselling

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Neurology

The Department of Neurology was estab-lished in 1955 and since then considerableprogress has been made in neurologyservices, training and research. The cominginto existence of the National Institute ofMental Health & Neuro Sciences in 1974,had a significant impact and providedmomentum for accelerated growth in clini-cal, investigative, therapeutic and comm-unity neurology, education and training andresearch activities.

The structure and functions of the depart-ment were designed to realise the goals en-visioned by the founders of this institute andwork was carried out with inspired determination- and dedication.


The Department aims to provide trainedman-power for clinical and academic neuro-logy in an attempt to fulfil the basic needs ofour country which presently has less than200 fully qualified neurologists.

Postgraduate training programme of 3years in neurology, leading to a degree in DMwas initially offered to students with MD inmedicine or paediatrics. Subsequently, inkeeping with national requirements and toattract outstanding students, direct entryafter MBBS was introduced for a 5-yearcourse. Intensive training in clinical neu-rology and allied disciplines, investigativeneurology including electrodiagnosis, neuro-radiology, basic sciences and researchmethodology, is Offered. G uided and inzreas-ing clinical and practical responsibilities,case discussion, journal clubs and seminarswith active participation of the student is em-phasised rather than imparting knowledge

by didactic lectures. Interdisciplinaryapproach is the central core of the trainingprogramme.

The department also provides training inneurology to postgraduate trainees of otherdisciplines of this institute, viz. M.Ch. Neuro-surgery, DPM and MD in Psychiatry, M.Phil.and PhD. in Neurophysiology, Diploma inPsychiatric and Neuro-Nursing. With theincreasing awareness of the importance ofneurology in the training of internists andpaediatricians, post - graduate students of MDin medicine and paediatrics of MedicalColleges in Karnataka and other states areregularly posted to this department forperiods of 2 to 3 months. Similarly postgra-duates of psychiatry of other institutes in thecountry are provided training in neurology.

The department has well equippedlaboratories for electroencephalography,electrotieuromyography, evoked potentials,poWgiaphy and doppler ultrasonography.Knowledge, expertise and technical skills areimparted to consultants and specialists ofthis country and neighbouring countries.Technicians sponsored by institenns arealso given training in electrodiagnostics. Theparticipation of faculty in several variousforums of Indian Medical Association andother organisations is a regularphenomenon to disseminate the advances inthe field of neurology.

SERVICES

Neurological,services are offered at out-patient and in-patient levels. A systematicfollow up which is essential for long termcare has been achieved by the intense effortsof the medical and para-medical personnel.

Special attention is given to ensure drugcompliance by proper ,education anddispenSing drugs 'at the out-patient to theneedy poor. In Addition to general and'special wards, the "Intensive respiratoryunit" was established in, collaboration withthe ,department= of neuroanaesthesia, foremergency treatment of neurogenicrespiratory disorders. An, analysis ofMortality rates of Guillain-Barre syndrome,myasthenia ;and gravis, has shown aconsiderable decrease as a result of promptand intensive ventilatory support. Patients

from sister institutions in the cityare often re-, ferred for, expert management by the team of

neurologists and, neuroanaesthetists. Anather important developMent was theestablishnient ofpaediatric neurology.Theteis no organised clinical service or trainingprogramme in paediatric neurology' anddevelopmental neurology in the country.Therefore,there is an urgent need to fosterthis discipline, since children constitute asignificant percentage of individuals withneurological disorders. A beginning hasbeen made in this institute by starting aseparate paediatric, neurology ward.Working in close conjunction with childpsychiatry a nucleus has fOrmed, and ,it ishoped that this branch will gain strength andgrow steadily culminating as an independentdiscipline of "Child mental health anddevelopmental disabilities".

Strokes form an important category ofhospital admission and is one of the majorcauses of death. With the establishment ofthe Doppler ultrasonography laboratory, ithas become possible to detect stenotic andocclusiVe lesions by a non-invasive method.By routine use, it has become possible toinvestigate a large number of "stroke"patients. Working in collaboration with theneurosurgical team, vascular surgerybeing done. However, a significant numberof patients either do not require or are notsuitable for surgery, for whom intensive carehas to be given in the acute stage to minimisethe morbidity and mortality. Plans are

underway to set up a Stroke Unit incollaboration with the department ofneuroanaesthesia and neurosurgery, withfacilities for monitoring various parametersand trial of newer methods of decreasingcerebral metabolic rate.

Despite medical and surgical manage-ment a number of individuals have residualphysical disabilities preventing productiveand useful life., neurorehabilitation sectionhas been planned with the components ofphysiotherapy, occupational therapy, pros-thetic section and rehabilitation. This con-cept is currently, in the process of becoming areality..

Laboratories

Laboratories have been established tomeet the demands and needs of clinical ser-vice, training and research. Electroencepha-lography laboratories with facilities for poly-graph recording, electroneuromyographywith computer facilities, evoked potentialsand Doppler ultrasonography have been set

Expertise generated in these fields hasgained recognition.

is proposed to set up soon a "neurouro-logy" laboratory for indepth assessment ofneurogenic bladder by electrophysiologicaltechniques and urinary flow dynamic stu-dies. The data obtained will be useful for pa-raplegia rehabilitation including bladdertraining and for cotrective/prosthetic sur-gery or implantation of pacemakers.

RESEARCH

Sustained indepth investigations of vari-ous aspects of neurology are under progress.Most of the information has already beencommunicated in scientific publications andpresented at National and International con-ferences.

1. Clinical and electroencephalographicfeatures of epilepsy were investigated asa national "Collaborative study onEpilepsy" funded by the Indian Council

5.

of Medical Research .and PL-480 Afollaw-up study was continued to assessthe degree of seizure control. Specialactivation procedures 'and, sphenoidalEEG'were standardised. &new type ofreflex-epilepsy-, "hotivater epilepsy"predominantly seerpin :Karnataka hasbeen. .documented. This entity hadaroused COnsiClerable interest in view ofthe -topical occurrenceand the specialclinical features. Studies have beeninitiated to assess the iong.term, effectsof febrile convulsions childhood andthe later -occurrence of epilepsy. Care-control Studies 'have commenced todetermine the factors for epilepsy inorder to understand-the reasons for thegreat :frequency of epilepsy in ruralcompared to semiurban population.

2. Viral infections of. central nervoussystem particularly "Japanese Encepha-litis" has been extensively tudied incollaboration with the department ofneuropathology and the NationalInstitute ofVirolOgy,Poona.The specificclinical and pathological 'features havebeen characterised. Long-term follow-up of the survivors is under wayl- todetermine the late neUropsychiatricsequelae of this devastating disease.

Tuberculosis of, central nervoussystem with particular reference toimproving-the diagnostic accuracy andlate complication of ,cranial and spinalarachnoiditis has been studied.Experimental work to study theevolution of process of ,arachnoiditisand the therapeutic response to enzymehyaluronidase has been carried out. Inthe clinical setting, the therapeuticefficacy of the enzyme has beenestablished.

Detailed studies of other infections ofcentral nervous system such asSalmonella typhi, fungal and parasiticinfestation (neurocysticercosis) havebeen done. The guidelines for

recognition and management havebeen evolved.

3 The spectrum of peripheral neuropathywith particular reference to G uillain-Barre syndrome, collagen vasculardisease, leprosy and neurotoxicsubstances, has been a subject ofsustained study. Special electrophy-s!ological techniques have been evolvedand diagnostic implications demons-trated for early detection -and progno-stication. Phrenic nerve conduction inGuillain-Barre syndrome has beenfound useful. for 'predicting impendingventilatory failure. Ulnar dorsalcutaneous branch and greater auricularsensory conduction techniques for earlydetection of 'nerve damage in leprosy,have now found a place in the standardbook on leprosy.

Neural leprosy cell was established tointegrate leprous neuropathy in themainstream of neurology and to facilit-ate detailed analysis and study of nervedamage in leprosy.

4. With the setting up of the Doppirultrasonography laboratory it has

-become possible to investigate a 'largenumber of "stroke" patients fordetection of extracranial stenotic/occlusive lesions by a non-invasivetechnique. For selected patients,vascular surgery had been done withsatisfactory outcome.' Study of riskfactors in stroke and stroke in the youngis under progress.

5. An interesting condition initially termedas "South Indian paraplegia" laterknown as 'Tropical spastic paraplegia"was described. Despite detailedinvestigations, aetiological basis could.not be established. This remains achallenging problem.

6. A large number of individuals withWilson's disease have,been studied andthe 'clinical features with specific

..

relation to bone changes, the long termcourse with treatment have beenanalysed. The high incidence of thiSdisease in this part of the country is ofinterest.

7. laemyeknating: disorders like 'multiplesclerosis have been studied in detail.The,oritico-ipinalform:was found to bethe commonest type. By detailedelectrophysiologicar studies,blink reflexand so matosensory evoked potentials, itwas found that morethan one thirchofpatientS- of optic neuritis may titivgMultiple sclerosiS. EncePhalornyelota-

'diculoneuropathy due to antirabicvaccination :has been studied in depthand documented.

8. An interesting variant of Motor NeuroneDisease "M6nomelic Amyotrophy",with single limb involverrient andbenign course has been 'documented.This entity has attracted internationalattention.

9. Clinical features and biogenic amines-have been' studied in a variety ofmovement disorders. Various modes oftherapy have been evaluated..

10. Neuroepidemiological studies are inprogress. A simple method, ,using non-professionals and meagre resourcesand combining "survey"'with "service"was evolved. This has been highlycommended by international expertsand recommended as .a suitable modelfor developing countries with in-adequate trained man-power. Thespectrum of neurolcgical disorders in.rural and semiurban population hasbeen determined by a door-to-doorsurvey. After the initial phase of"descriptive neuroepidemiolOgy"rAenext phase of "analytical neuro-

epidemiology" is under progress. Workon analysis of risk factors responsiblefor higher incidence of epilepsy in,ruralcompared to semiurban population, is inprogress.

Community Neurology

The department of r.eurology is activelyinvolved, in the sphere of- communityservices. A -full complement of a team offaculty and residents regularly visit the foursatellite centres and offer out-patientservices.

4.Pioneering work in neuroepidemiology at

Gowribidanur, one of the satellite centres, isunder progress. Houseto-house survey of,semiurban and rural population for determi-ning the prevalence of neurological dRord-ers in the community is gainfully combinedwith service offered at this centre. This com-bination has been found to be ideal in moti-vating individuals to disclose informationabout neurological disorders, includingthose such as epilepsy associated with socialstigma.

FUTURE PLANS

An 'important step is to consolidate thework of various ongoing activities and pro-mote the growth of identified areas, Establi-shment of stroke unit, neuroepidemiologyunit an_d neurourology laboratory are someof the activities. The 'discipline of paediatricneurology has to be nurtured and integratedwith child psychiatry to evolve as anindependent discipline of "Child mentalhealth and development disabilities".

Experimental neurology laboratorieshave to be established for trainingpostgraduate students and for research work.in problems of topical and current "world-wide" interest.

is,010rp

aT

.41,01471..,,,1

Neurosurgery

The Neuro Centre' was the best gift toNIMHANS on the eve of its formation in1974. The sound conception on which theNeuro Centre was based, has provided thebest atmosphere for the growth of neurosur-gery during the past decade which forms themost formative period of an ongoing processof development of the speciality of neurosur-gery, established in the erstwhile MentalHospital and AIIMH, Bangalore in 1958.


Manpower generation has been one of theprimary ablatives of the Institute.Postgraduate training in neurosurgerycommenced in 1972. The first successfulstuden came out in 1974. The intake ofnumber of students was increased from twoto four in 1978. Till February 1985, 21candidates have obtained M.Ch. degree inneurosurgery from this department.

Courses and demonstrations are offeredto General Surgery postgraduate studentsduring their posting to this department fromdifferent medical colleges of Karnataka. Inaddition to M.Ch. Neurosurgery, teaching forDM (Neurology), MD (Psychiatry) and theother nursing courses are undertaken by thefaculty.

Qualified neurosurgical specialists arelimited in our country. This necessitatestransporting of patients with head injuries toa few specialist centres. The department hasinstituted training of general surgeons ingovernment service for a period of onemonth in the Institute, so that they managethe head injury patients in' their regionpromptly and efficiently. In this programme,the general surgeons in government service

from Karnataka were deputed for training inthe Institute. So far 43 surgeons have beentrained in this programme.

SERVICES

Neurosurgery out-patient and follow upclinics are held three days a week. Neurosur-gical emergency services are availableround the clock. The out-patient attendancehas increased from 4,500 in 1975 to 10,991in 1984, which is more than 100% increase.

Hospital AdmissionAdmission to surgical service was 1,250 in

1975. For the past three years it has beenaround 2,200 per year, a rise of 68%. Thiscould be possible, partly because of additionof a fourteen bedded paediatric neurosurgical ward in 1980, and more so due toquick turn over of patients It is felt that withthe available number of beds, this is themaximum number of neurosurgical patientsthat could be adequately attended to.

Special ClinicsSpina bifida clinic. This clinic was established..11980 to provide total care to the childrenwith these congenital deformities. Theresponse has been very satisfactory.

osttrauma clinic This clinic sta.aed in1979, offers a comprehensive new osurgicaland psychiatric care i.icluding rehabilitationto the patients with traumatic sequelae.

EXTENSION SERVICES

As part of the Institutes multispecialityextension services in peripheral centres,members of this department attend 4extension clinics.,ome a month, detect andtreat cases of nee.: surgical disorders.

:17 .39

Patients requiring investigations andsurgery are called to NIMHANS foradmission. The clinics have proved to be ofgreat advantage to the people of theseregions, enabling easy access to specialistcare and follow up.

Follow up ServiceOur follow up services are worth mention-

ing. In 1975, 1,400 patients attended followup clinics and in 1983-84, 5,416 patientscame for follow up. It has achieved a 200%rise froM the 1975 figures: The rise speaksfor itself the quality of care and attentionoffered to the patients.

OperationsNumber of operations conducted per year

was between 600 and 900 till 1976. From1977 Onwards there has been a steady increase in the number of operations, toachieve a 50% rise by 1981. Since 198)., thetype of operations have .significantlychanged, with the number of operationsbeing around 1,400 a year. The output insurgical department depends on several fac-tors, including availability of optratinghours, number of surgeons and anaesthe-tists. Such high output could be possible Le-cause of availability of two operationtheatres exclusively for neurosurgery, andmore so due to a band of dedicatedanaesthetists, residents and surgeons.

With the availability of expertise andequipments, the quality and types of opera-tions have had significant advancement dur-ing the past decade.

MicroneurosurgeryAn operating microscope was obtained in

1979. The second operating microscope

with colour T.V. monitoring and recordingsystem was added in 1982.

The use of microscope in neurosurgeryhas been only a decade old in India. We havecaught up veil, and how many surgicalprocedures are performed with microscope.It hasbeen,possible to provide complete andsafe surgery with the aid of microscope,micro-techniques and peroperative Moni-toring.

Microsurgery of tumour, intracranialaneurysms, ct ?.bral and spinal vascularmalformations, intramedullary tumours andintraextracranial small vessel anastomosisare certain advanced procedures which havefound place in the routine list of operations atNIMHANS.

Stereotaxic Surgery

Chemothalamotomy for parkinsonismwas developed in this department some timeback. A sophisticated Laitinen's stereotaxicframe was obtained in 1980. In order tofacilitate the stereotaxic surgery a system ofx-ray source in two directions was installedin operation theatre. After a long periodof teething troubles, now stereotaxic surgeryfor parkinsonism has been a routine procedure. We wish to judiciously extend thism Dde of treatmerit, to other areas of functi-onal neurosurgery.

Monitoring Facilities

Monitoring of vital parameters, includingintmcranial pressure, during operation andalso while on intensive care has reduced themorbidity and mortality in major intracranialope, ative procedures. Intra -operativeevoked potential monitoring a sophisti-

16 40

cated means of observing changes of brainand spinal cord during operation, will soonbe introduced.

Advanced Surgical Aids

Use of ultrasonic aspirator and laser inneurosurgery has revolutionised the surgicaltreatment of many conditions which werethought to be beyond help. The departmenthas recently acquired CUSA (Cavitron Ultra-sonic Suction Aspirator) which has been putto use effectively. It is intended to procureLASER equipment shortly.

Investigation Facilities

Conventional radiological proceduresand electro-diagnostic techniques were wellestablished by 1975. From the time of ft--mation of NIMHANS, efforts were made toacquire a C.T. Scan.- It couldbe achievedonly in 1982. Soon after, a highly sophisti-cated biplane angiography machine hasbeen installed with provision for tomogra-phy and rapid serial x-ray facility. There isscope of adding a digital tomography to thismachine.

Neurophysiological aids and neuropsy-chological means of diagnosis have providednewer dimensions to brain lesion localisa-tion. All these developments in NIMHANShave occurred in the last five years.

RESEARCH

Research activities have slowly picked up.Though the development has been tardy, agood beginning has been made. The thrustareas are:

1. Cranio-cerebral trauma prognosticfactors and psychological impact ofhead injury on children.

2. Study of central canal of filum terminalein communicating hydrocephalu3.

3. Study of posterior fossa cystic arach-noiditis.

4. Hydrodynamics of A.V. fistula in arteriovenous malformation.

5. Visual failures in tuberculous opto-chiasmatic arachnoiditis.

6. Role of shunt operation in post-meningitic hydrocephalus.

7. Epidemiological study of C.N.S. malfor-mation.

8. Experimental study on intercostal nerveand cauda equina anastomosis.

9. Study of cranio-vertebral region anoma-lies.

FUTURE THRUST AREAS

The department has an ambitious andcomprehensive plan for its growth. Thedepartment wishes to develop thespecialised an- as in which development isproposed. They are:

1. Peroperative evoked potential moni-toring and use of LASER and CUSA toimprove surgical results and safety ofsurgery.

2. Rehabilitation ward to give compre-hensive care for the neurologicallydisabled.

3. Development of an experimentalanimal laboratory to train neuro-surgical trainees in microneurosurgery.

INN

1:11

3.1

4. Research work on neural tissue anomalies, hydrocephalus and occ-transplantation and regeneration, cra- lusive cerebrovascular diseases areniocerebral trauma, craniovertebral proposed to be concentrated.

Neurosurgery in progress

42

atric Social Work

The first psychiatric social worker wasappointed in the Bangalore Mental Hospitalin 1963. In the beginning, the social workservices offered to the mentally ill and theirfamily members were confined to the wards,rehabilitation units and psychiatric out-patient departments. In fact, it was in theform of systematic social service to thepatients brought to the mental hospital,admitted to, the wards and to those attendingfollow-up programmes. In 1976 the depart-ment of Psychiatric Social Work wasseparated from the department of psychiatry.Since then the department has been on themarch year after year.


The need for an advanced programmewas felt and accordingly, the trainingprogramme for psychiatric social work wasstarted in 1968 known as Diploma inPsychiatric Social Work. Four seats weresanctioned for this course per year, whichlater on increased to eight and subsequentlyto twelve. The DPSW programme wasredesignated as M. Phil. in Psychiatric SocialWork, in 1978, in keeping with emphasisneeded for the profession. Research facilitiesleading to PhD. were also provided.

Since the department achieved an inde-pendent status, it has steadily progressed byadding newer programmes and greaterinvolvement in-the various activities of theNIMHANS. In fact, the Joint Conference of'Indian Societies of Clinical Psy.chology,Psychiatry, Psychiatric Social Work andNeurology held at NIMHANS in 1979,increased the inter-disciplinary awarenessamong the mental health professionals ingeneral and psychiatric social workers inparticular.

The psychiatric social workers ofNIMHANS have been an integral part of themultidisciplinary team. As such, in eachpsychiatric unit, there is at least one memberfrom the faculty of psychiatric social work.Asand when new programmes are initiated, astaff member of the department is involvedwith it, right from the beginning, mainlybased on the interest and specialisation ofthe member.

In addition to the training of M. Phil.(PSW) candidates, the department isconnected with training of psychiatrists,psychologists and psychiatric nurses.Similarly, they are involved with other shortterm training programmes offered to non-specialists and non-professionals. Themembers of the department cater to theneeds of training the students of post-graduate social work programmes fromdifferent universities from India and abroad.They also offer expert guidance andconsultation to different schools of socialwork and universities in regard to formula-tion of syllabus, training evaluation ofeducational and service programmes.

The training and consultation servicesextended by the department endows it withthe recognition of being a vital link betweenmental health field and social workprofession.

SERVICES

Psychiatric Social Work inHospital Units

The services rendered by psychiatricsocial workers to the patients in the wardsand the out-patient department are 'ameaningful mixture of indepedent thera-peutic activities at individual and grouplevels and programmes of inter-disciplinary

43

nature. 'fdair:on e:psyCho-''SCielal'itildY Of the Otients and their families,

formulatiOn of -social diagnoiis and pro-viding appropriate social treatment. Thismay be in the form of gathering informationand recording the case history, making homevisits and collateral contacts, explanationand education to the distressed familymemberS, and group interaction with in-patients and out-patients. Depending on'theproblems, family-centred case work servicesare offered. In such activities, psychiatricsocial workers make special efforts toinvolve the significant person in the helpingprocess. Mobilisation and utilisation of theresources in the family and the communityfor the welfare of the patients are the guidingprinciples of psychiatric social work services.As may be expected, etch and every psycho-social situation and problem pose greatchallenges to the psychiatric social workers.Efforts are being made to improve thequantity and quality of such services to theout-patients and in-patients mainly throughsocial network approz ch and the involve-ment of volunteers from social welfareagencies.

Psychiatric social work Child GuidanceClinics child psychiatry have long historyof intertwined links. Considering the natureof the problems and psychiatric -manifesta-tions in children, the focus on psychosocialsituations is well emphasised in the multi-axial classification of childhood and adole-scent disorders. Working with familymembers and teachers constitutes the mainactivity of psychiatric social work services.Therapeutic group activities with childrenand parents, individual discussions withsiblings, interpretation of the problem tothe school authorities, and liaison with childwelfare agency services are the importantcomponents of social work intervention.These services are offered both at out-patient and in-patient levels. In addition tosuch services, he/she collaborates withpsychiatrists and psychologists in organisingdifferent welfare oriented therapeuticprogrammes for the children and theirfamilies. Social work services in the childand adolescent unit have immense poten

tials for being models to their counterparts inIndia and other developing countries.

Psychiatric Social Worker inFamily Psychiatric Centre

The psychiatric social work services focuson the marital problems and otherinterpersonal adjustmental difficulties in thefamily. These are handled at individual andfamily member levels. Simultaneously, allthe family members admitted to tH centreare. guided to participate meaningfully ingroup sessions in order to explore thepossible solutions to their problems. Suchtherapeutic programmes which are applic-able to our socio-economic and culturalmilieu are being extended to the families,mainly with the increased participation ofpsychiatric social workers.

Psychiatric RehabilitationRehabilitation is one of the core activities

of psychiatric social work. Employability,integration into the community and re-socialization become important areas ofservice of the psychiatric social workers. Therehabilitation potentials of the patients areassessed in accordance with the 'helpingpotentials' of the family members,supporting nature of the relatives and friendsand community resources. Problems to beencountered at each and every stage ofvocational and social rehabilitation arestudied individually and appropriate psycho-social solutions are offered to the patientsand their families. Involvement of philan-thropists, industrialists, welfare agencies andcoordination of welfare services is sine quanon of social work programmes in thepsychiatric rehabilitation unit. Theprofessional knowledge and efforts areinvested in organising rehabilitationprogrammes, development of psychosocialrehabilitation avenues and guidanc inutilising the resources. D ifferent attempts aremade to evolve the indigenous means ofrehabilitation of the mentally ill andhandicapped in urban and rural settings.

Social Work Services in .

Community Mental Health UnitThe methods of community organisation

tt

scOal',0,ctiOn,are.the Main, modes ofdeliVering mental health services in rural and.urban communities. Community participa-tion and mental health education areimportant dotinains Of psychiatric social workservices. So Cial workers play an importantrole by participating . in domiciliary careprogrammes, clinical services. in thecommunity and training programmes for the'Medical and non- medical personnel. Localleaders' in mental health prOgrammes arealso involved. Similarly, involvement ofStudents, teachers, volunteers and othersinterested in mental health programmes indifferent welfare activities has been the focusof action.

Social Work Programines inNeurology and Neurosurgery Units

Patients with neurological illnesses,neurosurgical problems and handicaps areoffered the services of psychiatric socialworkers in understanding the underlyingpsychosocial issues. This help is in the formof .education to the patients:and the familymembers, case work services to thedisturbed family and providing specificrehabilitative services.Particular attention isbeing given to chronic disabled patients.

Families are counselled and guided inregard to their future activities and are wellinformed about the social security servicesand other resources of help. Regular homevisits, agency contacts and social andvocational rehabilitative measures areundertaken in maintaining high follow-uprate in neurology and neurosurgery units.

Co-ordinating Services in Neuro-psychiatric Extension Programmes

The neuropsychiatric extension prO-

grammes being organised in Kanakapura,Maddur, Madhugiri, Gunjur and Gouri-bidanur coordinated by the psychiatric socialworker serves as a link between theNIMHANS team and the respectivecommunity representatives. He activelyparticipates in community meetings todiscuss different aspects of organisation ofmonthly services, fund raising, communityawareness and participation.

In addition to these monthly serviceprogrammes, psychiatric social workersparticipate in mental health camps, mentalhealth exhibitions and other allied activitiesindependently or jointly organised byNIMHANS.

RESEARCHThe research activities cover a wide range

of areas.The study on the efficacy of social work

measures in the treatment of anxietyneurosis proved effective, wherein it wasfound that. the patients retain the effects ofthe treatment even when the treatment waswithdrawn. It was also found that social workmeasures in combination with psychiatrictreatment showed a linear trend when theywere assessed during treatment, aftertreatment and even after the follow-up, andpatients treated only by psychiatricmedicines showed good improvement whileon treatment but zero improvement whenmedication was stopped.

The study on rearing practices and theirconsequences proved that unsocial type ofupbringing may possibly lead to neuroticproblems, antisocial upbringing may lead topersonality problems; and a social up-bringing may lead to severe psychiatricproblems.

In the social diagnosis of neuroticconditions the observations were thatneurotic patients experienced more stressfullife events as compared to normalpopulation; stress in the area of educationwas related with hysteria and anxiety, andbereavement with depression. Neuroticismdimension was related to neurosis as such.However, experiences of stressful eventswere found to be independent of personalitydimension.

The study conducted on treatment of schi-zophrenic patients both at home and inhospital proved that:(a) home treatment for a schizophrenic

patient was economical and practical(b) patients treated at home showed advant-

ages in spheres of clinical improvementand social functioning ability.

.ur en- on, farnilies Of PAtientstreateclat hbnie reduceCIsignilicantly.

(d) attitude of relatives towards mentalillness showed gobd improvement iftreated at home.

Further this study also was able to bringout a improved version of a parameter onfamily burden.

The study on post-hospital adjustment ofdischarged mental patients revealed thatrehabilitation of non-schizophrenics waseasier compared to tie schizophrenics.

The study on the family interaction ofneurotics showed significant pathologicalconditions among the members of the family.The neuroticism dimension was also foundto be independent and not related to stressfullife events.

In regard to the study of long stay patientsin the hospital, it was found that the stay ofthe patients was directly related to the threesystems namely, the hospital, the patient andthe family and, as such, they perpetuated theproblems of long stay of the mentaiy illpatients.

The study on walk-in clinic drop-outsprovided the results that a long waiting listand the diagnosis of depressive neurosiswere significantly associated with drop-out;and, drop-outs are associated with lack ofcongruence between the expectations ofpatient and the therapist.

The study in respect of the efficacy ofmultiple family group interaction proved thatoptimal mixture of advice, insight andsupport was important for a cultureappropriate psychotherapy in our setting

In a study of family violence from asystemic perspective, a new classification interms of physical violence, verbal violence,social violence, emotional violence andintellectual violence is suggested.

In a comparative study of alcohol addicts,no relapse is observed in cases treated withfamily therapy and group thi-zapy whencombined with medical therapy. On the otherhand, relapse rate after cnie year was above80% in the cases treated with behaviourtherapy + group therapy, and 70% in

the cases treated with medical + grouptherapy.

Using interactional scale it is observedthat families of neurotic patients are havingdefinite pathological interactional pattern atthe level of communication, concern andleadership.

In addition to these research work,different projects connected with theneurological patients and services form themain area of research activities of psychiatricsocial workers. In collaboration with otherdepartments they are involved with epide-miological studies, family interventionstrategies, evaluation programmes and thelike. Attempts are being made to constructresearch tools that are applicable to oursettings. These research efforts would nodoubt, strengthen the knowledge andpractice base of psychiatric social work ingeneral.

FUTURE PLANS

- To organise psychiatric social workservices in different welfare agencies.To incorporate psychiatric social workservices in labour welfare and personnelmanagement programmes in industrialsetting.

- To focus on the community efforts toorganise rehabilitation agencies in theirlocalities like half-way homes, day carecentres and special schools.

- To develop the psychiatric social workservices in educational institutions -schools and colleges.

- To enlist the social service support fromstudent service organisations and othervolunteers for the welfare of mentallydisabled persons.

- To organise periodical inservice tmining.programMes to the professional socialworkers working in the mental healthcentres and teachers working in teachingdepartments of social work.

- To develop models of training in psychia-tric social work.To extend the field work placement forM. Phil. trainees in community agencies inaddition to the present postings.

.;

To help/guide the Schools of social work tostart M. Phil/research programmes intheir centres.To collaborate with national level welfareorganisations.To develop further the special fields likepsychiatric rehabilitation, social work withchildren, family, the aged, community andneurologically ill and disabled.To introduce regular training programmesfor nontprOfessionals from social welfareand education fields.To develbp'sUitable models of psychiatricsocial'woik services in bur country.To focus on the monitoring mechanisms inpsychiatric social work services.

",

To investigate in a prospective mannerinto the psycho-social itatrik ofpsychiatric social work services in ourcountry.To focus on the monitoring mechanisms inpsychiatric social work services.To investigate in a prospective mannerinto the psycho-socio matrix in relation togenesis and development of psychologicalproblems and management.To develop the department into a Centrefor Advaced Studies and Research inSocial Work thus making it as an apexbody of psychiatric social workprogrammes for welfare agencies andUniversities.

4 4.: di, .6 > :,+,1 .F.,* a -

Family counselling session

2 5 47'

Netikoanaestheia

The opening of a separate block of NeuroCentre as part of NIMHANS in 1974 haspromoted a better coordination betweenvarious disciplines of neurosciences. Thishas been particularly true with respect torecognition and establishment of thedepartment of neuroanaesthesia with itsallied branches like neurosurgery andneuroradiology. An excellent rapport hasbeen established between the anaesthetist,radiologist and the surgeon, so that onecomplimented the other in patient manage-ment

MANPOWER DEVELOPMENTThe department has taken the respon-

sibility of training postgraduates ofanaesthesia from Bangalore University inneuroanaesthesia. The regular postgraduatecandidates from Victoria Hospital, Banga-lore, Bowring and Lady Curzon Hospital,Bangalore and Command Hospital, Banga-lore, are posted for basic training andunderstanding of neuroanaesthesia for aperiod ranging 1-11/2 months. During theirposting, seminars and lectures are arranged.They are taught how to use many sophisti-cated equipment.

SERVICESOver the last 10 years, there has been

initial phase of growth, followed byconsolidation of gains. Two, spacious, andwell equipped operation theatres wereopened in the Neuro Centre which areUnique in some wayb. Perhaps they are thelargest operation theatres in India. Secondly,radiographs can be taken from two x-raytubes permanently fixed in position inrelation to the operating table. All this hasmade many a complicated neurosurgicalprocedure possible including stereotaxy.

This necessitated that anaesthetists shouldcope with all sorts of neurological problems.Unlike other departments, the equipmentsnecessary for this task was not immediatelyavailable. It is noteworthy that in 1974, twoBoyles Apparatus for administering anaes-thesia, and a Halothane Vaporiser were theonly equipments. available. Monitorsnecessary for monitoring vital parameters ofthe patient were yet to be purchased. Manyintra-operative changes of the vital para-meters would go unnoticed. To add to theproblems, no ventilators were available forpost-operative ventilation when required.

Many sophisticated cardiac and othermonitors were purchased for routine intra-operative monitoring. The next improve-ment came with the additionJot a firstanaesthetic ventilator in 1976. With thearrival of the ventilator, perhaps the first onein Bangalore, many long procedures couldbe undertaken without much strain.Controlled ventilation during the intra-operative period was resorted to morefrequently. In 1978 one of the mostsophisticated and best ventilators availablein the world-servo ventilator was installed.This was followed by Engstrom ventilators inearly 1979. Presently this is one of the mostwell equipped anaesthetic departments. Thevarious range of equipments includesmultichannel telemetric monitors foz ICP,arterial/venous pressure, ECG, respiration,temperature etc., oxygen analysers, bloodwarmers, capnographs, dopplar ultrasoundinfusion pumps etc.

INTENSIVE CARE UNIT

The need for intensive care of postoperative patients and also patients withneurological diseases like GB syndrome,

48

myasthenia gravis, poliomyelitis vasrecognised long ago. Since 1976 attemptswere made to provide assisted or controlledventilation in post-operative period parti-cularly for patients with CP angle tumours orother brainstem problems. However,because of shortage of ventilators and alsotrained personnel, it was not until November1979 that a proper respiratory unit wasopened. Incidentally again, this was the firstrespiratory unit to be opened in Bangalorefor long term ventilation. By this time 4 birdrespirators and a few other simpleventilators were purchased. To start with,nursing staff were given training to managebed-ridden patients. With the successachieved with this 3-bedded unit, another 6-bedded recovery room for post-operativeneurosurgical patients was opened in June1984. With the addition of monitors andnew,sturdy ventilators with various possiblerespiratory functions like PEEP, CPAP, SIMVetc., this unit is capable of dealing with alltypes of respiratory problems. It is howeveropen only to patients with neurologicaldisorders. This is perhaps one of the first

centres in the country to institute routinemonitoring of ICP particularly in severe headinjury patients. In the beginning about 35patients were treated. Since the last one yearmany severe head injury patients are beingtreated with intensive management, whichso far was denied to this group of patients.Presently, more than 200 patients are beingtreated per year.

RESEARCHBecause of shortage of staff and non-

availability of basic amenities research wasnot given adequate importance in thisdepartment for a long time. Few clinical trialswere ur dertaken, but no publication could beproduced. However, in the last decade somereseard. activity has been undertaken andseveral papers have been published.

At present, the projects in progress are :

1. Comparative study of thiopentone andmannitol for intra-operative ICPreduction.

2. Use of thiopentone in the treatment ofmalignant cerebral oedema.

3. Aggressive management of head injurypatients.

4. Role of barbiturates in cerebralprotection.

5. Correlation between intra-operative vitalparameter disturbance and post-opera-tive BAEP study, in post fossa tumors.

FUTURE PLANSThe speciality of neuroanaesthesia as a

super specialisation is a reality. However,there are very few anaesthetists with goodtraining in neuroanaesthesia. Today manyneurosurgical centres are being set upthroughout the country. With this there willbe a shortage of trained neuroanaesthetists.The department, in pursuit of its policies, is

preparing to offer a one year trainingprogramme in neuroanaesthesia.

The department also has a proposal tohave a fully equipped respiratory functionlaboratory. The intensive care wardsrequire further improvements in serviceevaluated for. patients with cerebrovascular strokes atlanto-axial dislocationsetc., which so far could not be treated with allvigour. A modern intensive care ward with20 beds is being proposed in the seventh fiveyear plan.

In the last ten years, the department hasgrown to attain maturity and offer services,conduct research and involve in teachingprogramme.

50

'95Z:

Speech, Hearing and Language

With the creation of a taculty post inspeech pathology under the sixth five yearplan, the department of speech pathologyearlier under the department of neurologywith one speech therapist since 1970, wasaccorded the status of a full-fledged in-depend., it department on 4th August 1980.Since then a steady progress is noted in theexpansion of the department, with theaddition of one more faculty position and twopositions of speech therapists.

EquipmentsThe new equipments added are Maico

Dual Channel Clinical-cum-DiagnosticAudiometer, GSI 1723 Middle Ear Analyser,BA7 Bekesy Audiometer, three. channelledElectronystagnography, Tracor Analytic3000 Clinical Evoked Potential System,B &K Calibration Equipment, DigitalSonograph etc. The following equipmentswere also procured during 1980-85 for the-rapeutic purposes : Metronome, variablespeech control, speech trainer, shock therapyapparatus, noise therapy apparatus,Edinburgh speech masker, artificial larynx,and other speech therapy aids like toys andbooks.

f

i

t

--,

MANPOWER DEVELOPMENT.

The department does not conduct anyregular courses in the area of speech andhearing. However, orientation lectures anddemonstration classes are held for thestudent trainees of (a) DM Neurology(b) M.Ch. Neurosurgery (c) DPN and DPM(d) MD Psychiatry.,

Apart from the regular teaching to theabove students of NIMHANS, the depart-ment has been extending its services to othgrninstitutions in training their students in the

field of speech and hearing and in guiding thedissertation works.

With the increase in staff and addition ofadvanced diagnostic and therapeuticequipments the clinical work has recorded asharp increase. Evaluation of speech andlanguage has increased from 349 in 1980 to1034 in 1984. Similarly the number ofaudiological tests increased from 61 to 634and the number of patients treated increasedfrom 392 to 776.

The department acts as a referral clinicand most patients are referred from mentalretardation clinic, child guidance clinic,psychiatric and neurology and neurosurgical

OPD and in-patients. Besides, the ENTdepartments of Ft. John's Hospital, All IndiaInstitute of Speech and Hearing, refer theirpatients to this department for special help..

Speech therapy In progress

I

SERVICESThe various service actin sties of the

department are :(a) Providing rehabilitation clinical services

to the needy speech, hearing and langu-age disabled patients.

(b) Helping other departments in theirclinical investigations by way of con-ducting neuro audiological, speech andlanguage evaluations

51 I

(c)./-felPing other departments of NIMHANSand other institutions in their training andresearch by way of holding orientationlectures, clinical demonstrations,seminars and syMposia.

(d) Carrying out independent research in thearea of rehabilitation of speech, hearingand language disorders specifically ofneuro- psychiatric origin.

RESEARCHThe study of pattern of speech, language

and hearing disorders in rural populationparticularly among scheduled castes and

scheduled tribes was initiated in 1982-83.This 3-year project is founded by the Ministryof Health and Family Welfare, Governmentof India. The project is in the final stages ofcompletion. Data on 3500 people from rural,semi-urban and urban population belongingto scheduled castes/tribes and othercommunities has been collected and is beinganalysed.

Other Projects

The staggered paired word (SPW) test inKannada has been diveloped on the sameline as the SPW test in English to evaluate thepatients with central auditory dysfunction.Standardization of the test on normal popu-lation and its clinical efficacies are beingstudied.

A' pilot study on the audiological evalua-tion of post concussion syndrome thoughdoes not show a general pattern in thgauditory dysfunction, points to an abnorma-lity at the lever of brainstem. A detailed studyis in progress.

:yoked potentta: facility ABR under test

30.

ursing

The Department of Nursing has recordedia gradual and steady progress in the areas of

service, teaching and research activities.


The 12 months specialisation course inpsychiatric nursing was changed to 11months in 1975 and to 10 months in 1977which brought in uniformity with otherdiploma courses of nursing being offered inIndia. This course was also under re-evaluation and modification at differenttimes with the help of students evaluation ofthe course and based on suggestions givenby the faculty members of nursing and otherdisciplines who were involved in teaching.

In 1973, the WHO consultants helped toreorganise the DPN course and the samewas implemented from 1975. In 1978, thesyllabus was again revised and in 1982 theKarnataka Nursing Council inspected theDPN course and in 1984 onwards DPNcandidates started registering with theKarnataka Nursing Council because of itsaccreditation.

The 2 year MSc. in Psychiatric Nursingevolved by this department has beenapproved by the Board of Studies andAcademic Council of NIMHANS, andBangalore University, in 1984.

Psychiatric nursing in-service educationprogramme has become a continuous activity of the departmer.t from 1974 onwardsfor nurses and class `D' officials with aduration of 6 weeks. The department issuescertificates after successful completion of thecourse. The department is on the process ofpreparing a psychiatric nursing manual forthe inservice education course.

A short course in neurological nur:ingcare with WHO assistance under projectIND HSD 003 ward was conducted from 6 to8 February, 1978 under Miss Karen Plager,WHO Consultant (SEARO) with 6 partici-pants from Andhra Pradesh, Kerala andKarnataka and 6 from NIMHANS.

Nursing students of various categories likehealth assistants, multi-purpose healthworkers, general nursing, B.Sc. nursing (postbasic and basic) and M.Sc. nursing studentsof various nursing schools of AndhraPradesh, Tamil Nadu, Kerala, Maharashtra,Delhi, Punjab and Madhya Pradesh arebeing trained. Presently we are gettingapproximately 800 such students per year.The number of DPN and DNN ' studentspassed out from 1974 to 1984 are 201 and 2respectively.

SERVICES

To reflect the philosophy of amalgamationand education activities the nursing facultytook up dual responsibility in clinical areas aswell as in teaching. Integration of educationwith service raised the quality of the patient'scare and improved the learning experienceof DPN students under the close supervisionof the nursing faculty. The role of psychiatricpersonnel expanded as the service speciali-ties expanded to render sophisticated andspecial care to the patients.

The quality of patient care is improvingslowly but steadily with increased staffstrength. Now there are nurses from generalnursing to B.Sc. nursing and soi:.e. with DPNand DNN courses. The nature of nursingservice has changed according to the trendsin mental health field from seclusive care topatient government.

31

53

RESEARCHOrientation students of M.Sc. in nursing

who visit NIMHANS are guided for their pilotstudies. The departtnent is also engaged inindependent research work since 1983 tofind out the change in the attitude of nursingstudents before and after exposure to theclinical experience at NIMHANS.

54

Other ActivitiesThe department actively partiLgated in

the mental health week exhibition andreceived prizes in 1976, 1978 and 1984.DPN students participated in the exhibitioncompetition of Trained Nurses Associationof India in December 1981, February 1983and November 1984 and received prizes forall the exhibits displayed.

32

Physical Medicine and Rehabilitation

The Institute had a full fledged Rehabili-tation Unit for more than a decade, as a partof the Department of Psychiatry, offeringcomprehensive rehabilitation services tomentally ill and mentally retardedindividuals. The need for offering similarservices to neurologically disabledindividuals was felt a few years ago and asmall Occupational Therapy Unit for, thisgroup was started about four years ago.

This experiment lead into the formation ofan independent department of PhysicalMedicine and Rehabiiitation, offeringcompic.hensive rehabilitation services tomentally ill, menfally retarded andneurologically disabled individuals.

The psychiatric wing of the departmentwhich deals with all mentally ill and mentallyretarded individuals, offers assessment ofdisability, social rehabilitation includingbehaviour modification procedures andsocial skills training, occupational andrecreational therapy and vocational rehabi-litation as well as counselling, training andjob placement.

The Centre started with 9 units consistingof Carpentry, Printing, Tailoring, Spinningand Weaving, Basket Making, Pottery, MatWeaving Craft and Gardening, expanded itsactivities with the addition of a floor to thebuilding in 1979 and subsequently addedBakery, Candle making, Leather, Blowmoulding, Textile, Printing, Soap-Phenylmaking, Sericulture and Packing Units.

ActivitiesThe activities of the psychiatric wing

consists of a (i) Day Care Centre/DayHospital, which has 150 patients at any pointof time, consisting of schizophrenics of

subacute to chronic ir, nature, mentalretardation of mild to severe in nature,probably the largest such Day Care Centre inthe country, providing care for 6 days in aweek from 8 a.m. to 5 p.m. (ii) RehabilitationHomes for male and female long staypatients having around 50 patients in all,offering intensive psychosocial therapieswith the aim of preparing them from liv!rig inthe community (iii) Half Way Hornf.., forfemale patients, housing six patients at anytime, preparing them in household chors andfamily life.

The Rehabilitation committee consistingof industrialists, businessmen and philan-thropists is looking after this centre as a selfgenerating programme. Voluntary organi-sations and individual volunteers also helpthe centre in resocialisation, recreation, jobplacement and community placements ofthese patients.

Goods worth Rs. 5,40,000 are producedannually. Monthly cash incentives are givento each patient on the basis of scores theyget on a work performance scale and therapyi3 given according to the needs of individualpatients.

Residents and postgraduates are offeredregular training in various rehabilitationtechniques. The centre has offered suchtraining to workers of mental hospital else-where and to W.H.O. Fellows.

A wing for the Neurologically disabledconstructed newly will house 2 wards forfemale and male patients, therapy rooms andwill have comprehensive disability assess-ment, physiotherapy and occupationaltherapy. Apart from handling a variety ofdisabilities like cerebral palsy, hemiplegia,Rost meningitis and post traumatic

33

Syndrome, cervical spondylitis and spinaldisc lesions, the section alsoprepares severalorthiotic devices like collars, belts, gaiterssplints and crutches for this group.

RESEARCH

Among the current research activities, themore important areas are evaluation of DayCare_ Programme, work

, .

several groups of patients and behaviourmodification for chronic mentally ill group.

Future PlansAmong the future plans of the centre,

apart from expanding individual vocationalsections, and neurological disability wing, thedepartment has plans for more communitybased rehabilitation programmes than

based programines.

r 4

..y.sE.0-

4 tl

1- 6`

For the Neuroradiology Department thelast decade was a breakthrough in acquiringnew, equipment' and also in increasingpatient service. Though this departMentstarted in 1956, it had a chequered careerwith no faculty at varying periods. However,since 1973' the department is functioningwith regular faculty members.

MANPOWER DEVELOPMENTfwo Junior and two Senior Residents are

being provided with p,actical training inneuroradiology. Postgraduate students fromneurology, neurosurgery and psychiatry areregularly posted for training in neuroradio-logy. Postgraduate students in radiologyfrom medical colleges in the state are alsogiven training in neuroradiology.

EquipmentA 1000 mA x-ray unit with a fixed tube for

a AR in the operation theatre at a height of6 m and the lateral tube housed in a roomadjacent to the operation theatre is an assetfor radiological investigations both beforeand during surgery. A Klinoskop x -ray tablewith a new generator and a mobile x-raymachine were added in 1977 and 1978respectively. A Cordis pressure injector andan automatic film processor for carrying outtransfermoral catheter studies of thecerebral vessel were purchased in 1980 and1981 respectively. A linear tomographytable was attached to the existing Klinoskoptable in 1982. In the same year a C.T.Scanner (head) was purchased. With theintroduction of the C.T. Scan, a number ofinvasive investigative procedures likeangiograms, ventriculograms, pneumoence-phalogram etc., have been reduced. Preciselocation, size and probable pathology couldbe studied pre operatively. The equipment

also has facilities for corona' and sagittalreconstructions.

A fibre-optic image intensifier was at-tached to the Klinoskop table in 1983 whichfacilitated a better and clearer visualizationof the structures on fluoroscopy.

A biplane angiography equipment wasdonated by a public enterpriseMysoreSales International Limited in 1984. Thishas helped in conducting transfermoralcatheter studies of the cerebral and spinalvessels, with considerable reduction ofradiation to the patients and operator. Thdynamics of the blood vessels can be studieu.X-rays are obtained in both the planes with asingle injection thus reducing the complica-tion rate. It is highly advantageous forconducting interventional neuroradiologicalprocedures. It also has facilities for carryingout angio-tomography and to add on a digitalsubtraction unit.

SERVICESThe department carries out all types of

neuroradiological investigations with roundthe clock service to patients. The followingfigures speak of the increase in the workload . The number of patients investigatedhas increased from 5020 in 1975 to 9695 in1984. The number of myelograms done hasincreased from 205 in 1975 to 608 in 1984.The number of angiograms done in 1975was 794 which increased to 1047 in 1980.Since then it dropped to 872 in 1984, thisdrop being an universal phenomena. Withthe introduction of a C.T. Scan the angio-graphy rate has decreased.

Neuroradiology RecordsThe department has a neuroradiology

recording system which helps to retrieve the

. . I .I / 11

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Neurochemistry

It is one of the oldest departments in theInstitute, having .come into being in 1955with the object of service, teaching andresearch. The service includes besides.routine 'blood and CSF chemistrys, specialtests like therapeutic drugs monitoring andhormone assays. Besides carrying out

ti . investigations during working hours, round1- the clock facilities are also made available for

. emergency biochemical investigations ofdiagnostic .significance. Radfoimmuno-assays are offered as service facilities forpatients. For this purpose a 'LKB gamma'counter was obtained during 984.

MANPOWER DEVELOPMENTThe department is involved in teaching

neurochemistry to the postgraduate traineesof this Institute. In addition, this departmenthas its own PhD. programme in neuro-chemistry. The Govt. of Karnataka isdeputing candidates of medical colleges forpursuing PhD. studies in neurochemistry.

RESEARCH

Affective DisordersA series of biochemical investigations

were done on a longitudinal basis tounderstand the possible etiopathogenesis inpatients with affective disorders. In patientswith endogenous depression the levels ofbiogenic amine metabolites were followedbefore, during and after appropriate therapy.An initial decrease in the levels of biogenicamines were noted in many of the caseswhich raised with remission. The levels ofci..usol and electrolytes .were monitored toexamine the circadian rhythms and noconsistent pattern was noted, although theinitial levels of cortisol were elevated. Inmanic patients, attempts were made to

design a mode by which lithium could beadministered to achieve optimal therapeuticlevels without having the problem offrequent monitoring. This has been madepossible by using body weight as a referencepoint. With a view to examine the possiblereasons for side effects even at optimaldoses, studies were made to examine theionic fluxes. Using erythrocyte as a modelsystem, it was noted that non-respondersshowed altered membrane permeabilitycharacteristics.

Mental HandicapThe biochemical screening of mentally

retarded cases led to the detection of severalcases with inborn errors of metabolism. In allthese cases data relating to the geneticaspects were obtained. There appears to bea significant influence of consanguinity in theaffected families specially in those withmetabolic defects.

Spinal ArachnoiditisHyalase was administered in cases of

spinal arachnoiditis (developing as a com-plication of TBM) therapeutically. In suchcases, the CSF levels of hyalase weremonitored using a modified turbidimetricenzymatic method.

Brain TumoursIn patients with brain tumour, specimens

obtained at biopsy were biochemicallyexamined with special reference to varia-tions in isoenzyme patterns. It was noted thatthe isoenzyme pattern specially of LDH,closely paralleled histological alterations.Studies were also made to examine thevariations in isoenzy me pattern in humanfetal tissues at various stages of develop-ment. The. results indicated that there is a

59

characteristic pattern during development.This data during human fetal developmenthaS 'not* been reported earlier. ThisInformation is very vital for onto genic studiesof LDH'isoenzymes. In order to understandthe rnecharilSin of aromatic amino acid--hydroxylation, studies were made toevaluate the. role of superoxide dismutase.for this Purpose,nonenzymatic models wereemployed. The enzytne was also assayedlntissue obtained from the nervous system ofdifferent species of animais: The preliminaryStudies indicate that the enzyme plays asignificant role in hydroxylation mechanism.

VariOus research projects sponsored byICMR and IMRS were undertaken during this

period and studies on biochemical andgenetic markers in schizophrenia andaffective disorders; Biochemical and geneticstudies in mental retardation; studies onlithium and head injury are in progress.

FUTURE PLANSIt is proposed to have a separate estab-

lishment for isotope work useful not only fordiagnostic work but also for research; to setup clinical neurochemistry unit; to havefacilities for sophisticated biochemicalstudies in some of the disorders seen locally;to have a set up which is adequate foUndertake work in basic neurochemical

, problems since the Institute has now acentral animal research facility.

-;Netiropherhistrylaboratory

. ,

Neuropathology

The Department of Neuropathology, star-ted in 1956, has emerged as one of the wellestablished units in its discipline over the lastdecade.

During the initial stages of the last decade,priority was given to service and training ra-ther than research activities. Rapid strideswere made in the subsequent years and thedepartment has developed into a multi-func-tional unit. At present, it is one of the most re-cognised Neuropathology Centres in thecountry with the main objective of providingdiagnostic service to the patients, teachingbasic principles and recent advances in neu-ropathology to postgraduate students of dif-ferent disciplines and conducting clinical andbasic research in the field.


Regular teaching services for postgradu-ate students of DM Neurology, MD Psychia-try and M.Ch. Neurosurgery are being, con-ducted from 1975 onwards. Wealy braincutting sessions and slide seminars are uni-que to this centre helping in active interac-tion between the clinicians, neuroradio-logists, microbiologists and pathologists forbetter understanding and management ofpatients.

Short term training programmes inNeuropathology was initiated from 1982 on-wards for the out-station students. One totwo batches of students from different Statesof India regularly benefit from these coursesevery year. The faculty of neuropathologyhave been actively participating in Con-tinuing Medical Education Programmesconducted by the Karnataka State Branch ofIndian Medical Association, Neurological

Society of India and Indian Association ofPathologists and Microbiologists.

The department was initially looking afterhistopathology only, but since 1976, bothblood bank and clinical pathology laborato-ry were also taken charge of. The same yearan emergency laboratory was started and itwas located in the neuro-centre, nearer tothe operation theatre and post-operativeward. With the active collaboration of micro-biology and neurochemistry departments, a

.round the clock service was made availablefor emergency laboratory investigations inc-luding blood .bank service.

Blood Bank Service

Regular blood donation camps are beingconducted to collect blood from voluntarydonors in order eliminate professionaldonors. The relatives of the patients areencouraged to donate blood. From 1983onwards, screening of the donor for hepatitisassociated antigen has been introduced:Aprogramme of mutual exchange of bloodwith other nearby hospitals especially theKidwai Memorial Institute of Oncology incase of emergency has been developed. Thishas helped in having an inter-institutional co-operation in this vital service. Since May1985 a scheme of collecting blood fromvoluntary donors has been introduced.According to the scheme, staff members ofNIMHANS are donating blood once a monthvoluntarily. It is envisaged ti tat this bold steptaken by the staff members would solve theproblen-. of scarcity of blood to a great extent.

Autopsy ServiceThe autopsy service was started at

NIMHANS in 1975 and 14 post-mortems

,

EA'

were conducted during the year. However,during the subsequent years, round the clockservice was made available and with theactive efforts of clinicians and pathologists,the number of autopsies performed in 1976was 146. Since 1978 on an average, 225clinical and 250 medico-legal autopsies areperformed every year. The brains and otherorgans collected are submitted to detailedpathological studies and are utilised to buildup a museum for teaching purposes. Manyinteresting specimeris of teaching value areprovided free to various medical colleges inthe country on request. This preciousautopsy material is one of the largest assetsfor applied research and training in the fieldof neurosciences. In future it is planned todevelop a brain bank of frozen human braintissue for neurochemicai and neuro-pharmacological studies.

Electron Microscopy LaboratoryThe Electron Microscopy Laboratory is

functioning since February 1982 after installation of the transmission electron micros-copeThe facility is being utilised by thedepartment for research and diagnosticpurposes. This facility is also extended toother departments of NIMHANS and othersister institutions in Bangalore involved inbiological research. Apart from these, a fewbiosciennsts working in plant pathology andother biological sciences from out-stationlaboratories avail of the facilities for theirresearch projects. A Senior Scientific Officerwith specialised experience in electronmicroscopic studies assisted by a technicianprovides technical help to various workers. Itis planned to acquire a scanning electronmicroscope for freeze fracture studiesshortly.

HistopathOlogy Laboratory

On an average 500 neurosurgicalbiopsies are processed and reported everyyear. Rapid frozen section service initiated in1976 is provided for the operating surgeon.Addition of scintillation beta ,counter, electro

focussing equipment, microfluorometn, andphotometric attachments to Zeiss photomicroscope "T.. have added to th,? quality ofwork. In c._ _: to facilitate proper diagnosisof skeletal muscle diseases, enzyme histo-chemical and electron microscopic studiesare being undertaken for the past two years,in addition to the routine histology. Also,elaborate methods are being employed instudying peripheral nerve biopsies. As aresult muscle and nerve biopsies arereceived from different neurological centresof the country for diagnosis. Thus thedepartment offers referral service in the fieldof neuropathology.

RESEARCHThough the department is basically a ser-

vice organ of the Institute, considerableemphasis is being laid on aspects of researchon tropical and infectious diseases of the ner-vous system and neuro-oncology. In addi-tion, from time to time some aspects of deve-lopmental biology were also investigated. Asa general rule an inter-departmental andinstitutional collaborative approach isadopted.

In developmental aspects, intra cranialembryonic veins in human foetuses were stu-died, with a special emphasis on the develop.ment of arteriovenous malformations. Theexistence of arachnoidal villi along theintraorbital portion of the human opticnerves was described. It is proposed that theyhave an active role in modulating intraorbitalpressure and the evolution of the papil-loedema. An ultrastructural study of themotor end plate and systemic organisationalong the tail of a tadpole is in progress. Thisstudy provides an insight into the pro-grammed cell death during the evolution andmetamorphosis of the amphibian system. Along term project on the developmentalneurobiology of frog and Drosophila hasbeen undertaken recently with the objectiveof gaining insight into the morphologicaldevelopment with particular ref eren,:e tosynaptogenesis.

Ka4rata1S,a a confirmed endemicorie: o .-,arboviraL Infect ons,especially the

4 Japanse Ehcephalitls Du.ring the epidemicIn 'brains ob-tained-..-autopsywere'studied,indePth andpathoinbrphOl6gIcal featureS,CharaCteiised.'A synergistic effect of neurocysticercosis onthe ev o 1 Uti ory arid progression of the `lesions

'`Was recorded: This was an important and'Major, study inthe-CoUntry;The study is be-ing Continued.,

Neural leprosy still Continues to be a prob-lem' in trOpicS'. A ir UltraStitictirra 1 Study of thedorsal cutaneous branCh ,of`ulnar nerve, onwhich'rieurophYsiologiCa1 Studies have beenconducted is Undertaken. *Theiepra bacilli .are found to have a prediliCtion of rinmye-linated nerve fibres and tti6-scl:Oarin cells inrelation to these fibres. The Significance ofthis observation in the evolution of thepathological lesions needs further probing.

A/detailed study of the pathologicalchanges in various lesions observed in neu-rotuberculosis is being done. The effect ofshunt surgery on the cortical mantle and theassociated pathomorphological lesions are'assessed to examine the nature and reversi-bility of lesions. Por the first time, the natureand degree of involvement of the intraorbitalportion of the optic nerve has been characte-rised in neurotuberculosis.

In a study of animal experimental arach-noiditis effect of hyalase in resolving thelesions, appears to act on the groundsubstance binding the collagen. This opensup channels to partially re-establish the CSFcirculation and help in reducing the pressureon the spinal cord. This animal model isconsidered to *resent the possible mode ofaction in ,, humans.

Neurocysticerocosis is one of the well-known causes for epilepsy and otherneurological manifestations. Themorphological types of lesions and theirclinical manifestations are studied both atautopsy and biopsy with special reference tocysticercal encephalitis.

Psychiatric pathology is not well deve-loped in the country. A limited clinicopatho-logical study of dementia was conducted inwhich a spectrum of infective and degenerat-ive diseases leading to this malady were not-ed. A few formalin fixed brains obtained fromCases c` schizophrenia and tardivedyskinesia are preserved for study., In future,attempts will be made to complement thesewith neuropharmacological studies on freshfrozen brains obtained. at postmortem.

As a routine relatively uncommon braintumours are those posing diagnosticproblem and submitted for ultrastructural,studies. In addition some immunocyto-chemical studies have been initiated. Incbliaboration with the neurochemistrydepartment, the LDH isoenzyme pattern isstudied, which has, provided an insight intothe metabolic state and biological behaviourof the tumours of different grades of malig-nancy. In experimental neuro-oncogenesisby N-methyl nitroso urea in rats, the evolu-tion of the tumour from the preneoplasticstage to onset of tumour is studied, both bylight microscopy and ultrastructurally.

A detailed electron microscopic morpho-logical analysis of astrocytoma blood vesselsis in progress. The tumour vessels will becompared with human foetal and normaladult cerebral vessels for a betterumlerstanding of the morphological basisunderlying tumour associated cerebraloedema.

Histopathological study of the brainsobtained from epileptics is undertaken toevaluate the extent of tissue damage. A fewcharacteristic but not diagnostic alterationsare observed in the neurolonal morphology(golgi preparation and routine staining)dendritic and synaptic density and theirmorphology. This is the first studs, under-taken in India on this important aspect.

In view of a large body of autopsy materialavailable special thrust was given to studythe cerebrovascular diseases from 1982 on-wards. All the autopsied cases are reviewed

41, 63

-7, :

and Codified to v,arious categories. A detailed-pathological study is in.progress to establishbaseline data about the magnitude of theproblem and;its xelevance;to clinical prac-tice. The incidence of post-partum corticalvenous thrombosis is high in young femalescausing significant mortality and morbidity.The cerebrovascular anomalies and aneu-rysms are fairly common contrary to earlierbelief.

In the first five years, the main thrust wason developing the department into a serviceorgan and . establish training facilities,hitherto not available in this part of the coun-try. Having achieved reasonable results andconsolidated this aspect, both applied andbasic research activities were undertaken inthe next five years. The department hasachieved the distinction of being one of the

best centres in the speciality ofneuropathology in the country. Keeping thenational needs in view, tropical neurologycontinues to be the main- thrust area ofresearch complemented by studies in basicneurobiology.

In ProgressClinical and laboratory studies on Rey's

syndrome and other encepnalopathies inBangalorein collaboration with the Dept. ofpaediatrics, Vani Vilas Hospital, BangaloreMedical College are in progress.

Modulations of activities of the enzymes ofone carbon metabolism and morphologicaland cytometric changes in exprimental andhuman cancer are under study incollaboration with the Dept. of Biochemistry,Indian Institute of Science.

E/e6tron microscope in use

442

t .

Microbiology

This is one of the new departments startedduring the decade in 1977. The groupsinto which the activities of the departmentcan be classified are:

(i) Microbiological and immunologicaldiagnostic services for patient care,(ii) Teaching facilities to post-graduates ofneurology and neurosurgery and (iii) Basicresearch facilities in the existing CentralNervous System infections as seen at thecentre.

MANPOWER DEVELOPMENTThe department has practical training

programmes for residents after postgradua-tion in microbiology and orientation to thestudents of neurosurgery neurology andpsychiatry.

SERVICESPatient care is carried out by way of

routine diagnostic services. A variety ofsamples viz., cerebrospinal fluid, brainabscess pus, wounds, swabs, urine, blood,sputum, etc., are received at this laboratoryfor a spectra of bacterial and fungal cultures.A- series of serological and immunologicaltests are carried out on weekly basis. Some ofthe tests are VDRL serology test, widal test,rheumatoid factor test, C-reactive proteintest, complement fixation test for cysticercalantibodies, serum immunoglobulin assay forIgG, IgA and IgM. These tests are beingcarried out to solve the puzzle of infectiousdiseases of the Central Nervous System. Inmost cases of pyogenic meningitis, theetiology is established in 80-85 per cent ofthe cases. This department also helps theclinicians to confirm diagnosis of tubercu-lous meningitis by isolation of Mycobacte-rium tuberculosis from the cerebrospinal

fluid in a fair number of cases. The choice ofantibiotics in any given case of the CentralNervous System infection is eased by theantibiogram test carried out at thisdepartment. Thus, a timely and accuratediagnosis in the Central Nervous Systeminfection, saves many a life. Annually 10-15thousand tests of various types are carriedout for patient care and to help the clinicians.Since the last five years, cerebrospinal fluidcell cytology by the use of cytospin ininfections like tuberculosis andin malignantmetastasis of the brain have been carried outwith h'-ffily promising results. The cere-brospinal fluid cytology in routine diagnosisof the Central Nervous System diseases hasbeen established for the first time. The othernew dimensions of microbiological analysisare the introduction of Gas Liquid Chroma-tography to aid in rapid diagnosis ofmeningitis and anaerobic infections. Since1979 routine anaerobic cultures of brainabscess pus have been carried out and therole of metronidazole in brain abscess andother anaerobic infections has beenestablished. For the first time the entity ofanaerobic meningitis has been establishedby this project on anaerobic cultures. Theroutine fungal cultures of cerebrospinal fluidbrain abscess pus has brought out some rarefungal infections like Ciadosporiumtrichoides infections of the Central NervousSystem and it has also helped to identifyaccurately all cases of cryptococcalmeningitis (20 cases in 7 years).

The department in collaboration withother departments in the country likeDepartment of Microbiology, All IndiaInstitute of Medical Sciences, New Delhi,

Vellore, J.N. Medical College,Belgaum, School of Tropical Medicine,

,4a=

65

Calcutta, Veterinary College, Hebbal,National Salmonella Phage Typing Centre,Maulana Azad Medical College, New Delhi,have helped in the accurate diagnosis ofdiseases like Toxoplasmosis, Brucellosis,Listeriosis, rare Streptococcal infections ofCentral Nervous Systein, SalmonellaMeningitis and rare fungal infections of thebrain.

RESEARCHThe areas of research in progress at the

department are :

(1) Role of anaerobes in brain abscessesand meningitis

(2) Incidence of fungus.in central nervoussystem infections.

(3) Immuno diagnosis of neuro cysticer-cosis.

(3a) Serum immunoglobulin assay in psy-chiatric disorders.

(4) CSF cell cytology in tuberculosis ofcentral nervous system.

(5) Immuno diagnosis of TBM by mono-clonal antibodies in association with Dr.J. Ivanyi, Immuno Biology Departmentof Wellcome Laboratories, U.K.

(6) Bacteriological etiology of Pyogenicmeningitis.

(7) Role of GLC in diagnosis of meningitis.

(8) Incidence of C-reactive protein in CSF'sof meningitis.

(9) Isolation of Mycobacterium tuber-culosis in CSF's TBM cases.

(10) Anaerobic synergy in central nervoussystem infections.

A series of papers on the above mentionet.'projects have been presented. Severalpublications on these subjects haveappeared both in national and internationaljournals. The departtnent has representedwell in the National Conferences of Patho-logy, Microbiology, Neurology and Neuro-surgery annually over all these 7 years.

FUTURE PLANSIt is envisaged to set up an extension

diagnostic laboratory service at the NewPsychiatric OPD block and a new Nel.ro-immunology section at this department tofurther sharpen and increase the spectra ofdiagnostic test for Central Nervous Systeminfection and immunological disorders.

This 'Department is actively helping theestablishment of a Neurovirology Depart-ment at this Institute which when establishedwould be a great boon in solving theproblems of diagnosis and prognosis in allneurovirological disorders.

Neurovirology

After repeated efforts to recruit the facultysince 1983, the Department of Neuroviro-logy came into existence in 1985. At presentthe department is functioning as a part of theMicrobiology Departnient However, it willbe shifting to its new location on the top floorof the' administrative block. TF.e newlaboratory, one of its largest kind in thecountry, has been designed availing the helpof certain leading virologists in the countryfrom various institutions such as the NationalInstitute of Virology, Pune, Christian MedicalCollege, Vellore and the Pasteur Institute ofIndia, Coonoor.

The objectives of the department are:(i) to provide routine diagnostic servicessuch as virus isolation and 'antibodyestimation; (ii) to conduct basic and appliedresearch in the field of neurovirology withparticular reference to diseases of publichealth importance in this country; (iii) toimpart teaching to the postgraduate studentsof this Instill. te.

Work DoneIn the past one year construction of the

laboratory has been in progress and hasreached a stage of completion. Further, thenecessary equipments are being added.Despite the lack of a full fledged laboratory,serodiagnosis of Japanese Encephalitis (JE)has already been started and total of 30samples were tested for presence of JEantibodies. Samples are also beingforwarded through this department to otherinstitutes for virological studies which are notpossible here at present.

The postgraduate medical trainees arebeing given orientation lectures.

Staff PatternThe department has been sanctioned the

posts of a professor, a lecturer and two juniortechnicians. However, at present only alecturer and one junior technician have beenappointed.It is hoped that the other posts willbe filled soon.

FACILITIESThe new laboratory complex has a

number of facilities which include a P3facility (high contaminent laboratory),cubic/es for handling normal and infectedcell cultures, an immunodiagnostic laboratory, a separate departmental animalhouse to keep virus infected animals snob asmonkeys, mice and rabbits. The equipmentbeing purchased include Laminar FlowCabinets, Ultra Low Temperature ( 85°C)Cabinets, CO2 Incubator, High VoltageElectrophoresis apparatus, Chromato-graphy equipment, ELISA equipment,Refrigerated Super Speed Centrifuge,Fluorescence Microscope, inverted PhaseContrast Microscope and many others.

Future PlansThe department envisages to venture into

a few collaborative research projects onJapanese Encephalitis such as (a) Interferontrials in Japanese Encephalitis cases and(b) Development of recombinant DNA pro-bes for diagnosis ofJapanese Encephalitis. Itis hoped that these projects will be initiatedbefore the end of 1986.The department alsohas plans to conduct seroepidemiologicalsurveys in order to find out the extent ofcertain viral illnesses of the CNS. Anotherarea of future research is on the aspect of"Viral hypothesis of mental disorders:'

Long term plans are to cony,. :t this depart-ment as a reference laboratory for viralinfections of the Central Nervous System inthis country.

`it, 6745 t

Psychopharmacology

The Department of Psychopharmacologywas started in this Institute. towards the endOf 1983. The philoidphy of this departmentis to create, and deiielop a. group of.excellency in Mble'cular ,Psychopharmaco-logy for its application in service, teachingand researches in.the field of mental health &neurosciences. Appropriate Infrastructureand laboratories are under establishment forthe fulfilment of the aims and objectives ofthe Natione7I irtitute.

MANPQWER DEVELOPMENTThis department actively participates in

mental health manpower development byteaching and ,training of postgraduates inPsWhologica1 Medicine (MD. & DP.M), inthe cli-cipline of Psychopharmacology. Anuptodate advanced course in subjectincorporating mathematical models, biophysical and molecular mechanise of drugaction with special emphasis io psych:3Weconditions is being conducted regularly.Teaching and training of professionals arealso undertaken from time to time.

SERVICESQuantification of psychotropic drugs and

metabolites, and monitoring of neuro-humoral and biologic markers in psychiatricconditions are the major responsibilities ofthe department. These biochemical andpharmacokinetic parameters are essentialft,- patient care in the hospital. Thedevt.:1ipment of psychopharmacologicmodels for understanding the etiopatho-genesis of neuro-psychiatric conditions is theprimary requirement to the choice of arational therapy. This department bears theresponsibility of developing and applyingsuch models for better patient care.

At present the following analytic facilities

are available. (a) High Performance LiquidChromatography with electrochemicaldetection of sub-picomole quantities ofneurotransmitter amines and metabolites inbiological samples and tissues withSpecialised solvent extraction techniques,.(b) A specialised LC technique withcombined UV spectrophotometry forquantification of neurotropic agents hasbeen stand rd' ed. (c) Enzyinatic analysismethods ng ultracentrifugation, IEF andcolumn ch omatographic methods havebeen establ shed.

RESEARCHTwo major long term experimental

research schem , have been initiated in thedepartment with the limited facilities. Theyare: (a) The Molecular Dynamics c:Neuronal Receptors. (b) Enzyme RegulationSrstems in Brain. These schemes aim atunderstanding the biophysical, electrophysiologicil and neurochemical basis of drugaction at a molecular level in the centralnervous systc.ns with the help of thefollowing paradigms.

Drug Receptor Ion Channel Interaction .

The Patch-Clamp technique for single ionchennel recording is under developmentMembrane signal transduction mechanismsand influence of drugs in the modulation ofsuch information processing will be exploredwith the finest tools of molecular cyberneticsand computer models.

In Vitro Reconstitution Techniques: For asystematic exploration of molecular psycho-pharmacology different membrane andneuronal intracellular components are beingisolated, purified and characterised by themethods of Density Gradient Centrifugation,Molecular Sieving Chromatography, Elec-

trophoresis, BLM and Liposomes.

Behavioural Psychopharmacology: Theeffect of drugs on behaviour in rats are beingstudied for understanding the receptorsensitivity, under a variety of experimentalconditions by computerised animalbehaviour monitoring systems.

FUTURE PLANS

The department plans to provide postdoctoral training in Membrane Biology,Molecular Psychopharmacology andBehavioural Pharmacology on a regularbasis. It will also set up labs fOr visitingscholars and professors for sabbatical work.

Neurophysiology

The Department of Neurophysiology wasstarted in 1975 with the.appointment of Dr.T. Desiraju. Since its inception, the depart-ment has been striving to initiate and deve-lop its programmes in keeping with the con-cept of an Advanced Centre of a national ins-titute.

However, the progress could be signifi-cantly advanced only after the sixth fiveyearplan (1980-85) was sanctioned by thegovernment to the Institute for the first time.The overall objectives and the budgetrequirem4nts (under the plan) for thedepartinent and for the animal house, wereexamined by the expert plan committee andrecommendations approved. The mainfunctions of the department are:

(i) To carry out original researches onhigh priority areas of national relevance onthe nervous system;

(ii) To disseminate knowledge and teach-ing on the neurophysiological advAnces,techniques, methodologies, approaches andapplications;

(iii) To train personnel in short-term train-ing courses in neurophysiology and in long-term research degree programmes; and

(iv) To establish 'bridges' and ground forexpert consultations and collaborations inmultidisciplinary areas in brain research andneuro sciences.

The main areas of research investigationsproposed to be undertaken include.

(i) Development of experimental modelsof brain disorders, and advancement of bas!cresearch in neuro sciences;

(ii) Researches on consciousness;

(iii) Nutritional effects on brain develop-ment; and

(iv) Toxins and other debilitating environ-mental agents and fertility control.

.

In furtherance of the objectives the nextfive year plan (1985-90) was formulated sothat the future developments include thestrengthening of the infrastructure alreadycreated. Among the most importantPriorities is the development of trainedspecialists to advance medical education andresearch.


Teaching in Neurobiology

The specially structured programmes in-tegrating the current principles of brain de-velopment, functional morphology of neu-rons, synaptic physiology, mechanisms ofworking of the different brain areas and sys-tems and of behavioural and consciousstates, are delivered since 1976 to thetrainees of DPN, DPM and MD (Psychiatry),DM (Neurology), M.Ch. (Neurosurgery) andMPhil. (Clinical Psychology).

Training of Specialists

(I) PhD (Neurophysiology)

Soon after the establishment of researchlaboratories, the PhD. programme wasinitiated from 1980.Two candidates per yearare admitted on a regular basis, apart fromadmitting sponsored candidates from otheragencies and from thoSe appointed on theresearch schemes. This is the first docto-ral programme in the neurophysiologyspeciality started on a regular basis inIndia.

49 : 71.

,

(ii) MPhil (Neurophysiology)

In order to create necessary manpower inbasic neuro sciences, MPhil. (Neurophy-siology) a 2-year pre-doctoral programmewas started in 1982. As in advancedcountries, the course is open for both medicaland life-Kt/ice candidates. A s.this is the firstprogr6mnie of its kind in the country, a greatdeal of effort is being invested to conduct thesame on innovative lines.

(iii) Training for faculty members of othermedical colleges

The department has been providingadvanced educational training in theexperimental skills to the faculty members

:deputed from other medical colleges. Thesecategories include the short term visitingpersons and also the long term depu-tationists for PhD. under the faculty de-velopment programmes.

RESEARCH

Establishment of technical facilitiesand knowhow

The department establishes' one reseallaboratory during 1976 with some old andmiscellaneous equipment collected fromdifferent places in the Institute. In this earlylaboratory, the preliminary and theexploratory research work of the projectconsciousness was initiated. The departmentwas involved from its inception in building tr?of the animal house for animal experimentalwork. By 1983, the department establishedthe following five actively workingexperimental laboratories :

(i) Human neurophysiology laboratory,

(ii) Cellular and synaptic neurophysiologylaboratory

(iii) Psychuphysiology. laboratory

(iv) Functional-morphology laboratory

(v) Neurotransmitters physiology labora-tory

The department's research staff have alsobeen regularly using about VA days in aweek, sharing the common facility ElectronMicroscopy of the institute for carrying outthe correlated E.M. work of the neurophysio-logy research projects.

Further Areas of Research

The infrastructure of the laboratories forhuman neurophysiology and animalexperimental neurophysiology have beendeveloped to pursue projects by theacademic and research staff (currently about25) falling under the following fields :

(i) Human thalamic neuronal physiologyunder clinical setting while treatingparkinsonism etc. (starting shortly).

(ii) Physiology of Yoga

(iii) Effects of malnutrition on braindevelopment

(iv) Psychophysiology of behaviour andlearning somatic and automaticfunctions

(v) Morphological (...,nnections in thebrain areas

(vi) Neurotransmitters physiology

(vii) Effects of environmental pollution onbrain development

(viii) Abnormalities of the physiology ofsleep states in the depressive illness

(ix) Neurophysiology of the primatecerebral cortex

(x) 'Growth, maturation, degeneration,and regeneration of nervous tissue

Highlights of some of the importantapplied research projectsICMR supported project on Effects ofmalnutrition on brain development:

The project was sta:ted in April 1980 for aperiod of 3 years and has been renewed foranother 3 years from September 1983. Thisproject carries out experimental work usingrats and monkeys to find the effects of

V7250

undernutrition on the developing brain, andto find whether rehabilitatory nutritionwould restore the state of normalcy.

National Project on Consciousness

This project started in December 1976has been making steady progress since 1980with the development of laboratory withmodern facilities for human neurophy-siology wOrk. After the initial efforts ofexploratory ground work and standardi-sation of :the methodological approachesneeded for a complex area like this; the workbegan to be pursued. in an intensified way.From April 1984, the ICMR has sanctioned afive year grant of a tune of over-two lakhs peryear, to support a major research project onthe study of physical, physiological,biochemical and psychological aspects of theeffects of yoga.

ICMR supported Project on Thermoregu-,lation:

This experimental project was aimed tostudy the effect of succinylcholine on the hy-pothalamic thermoregulatorg mechanismsto find whether succinylcholine has action onit, as it sometimes causes malignant hy-perthermia in some patients. The projectwas' conducted between 1981-1984. Thestudy revealed that succinylcholine can acton the preoptic area leading to anhyperthermid effect. Based on this and otherfindings of the study, it has been postulatedthat succinylcholine might inhibit the warmsensors and the controls of the dualsympathetic. mechanism which normallylead to an increase of sua.motor activity and

'a decrease on vasomotor activity, thus theinhibition contributing to the rise of the bodytemperature. The study is aimed to beextended on to the primate experimentalmodel.

CSIR supported project on Electrophysio-logical Studies of Effects of Undernutritionon the Developing Brain of Primate:

Th's project started in 1984'is in progress.

Research in Areas of ClinicalNeurophysiology

A project was initiated by the departmentduring 1981-82 to study the nature of abnor-malities of sleep states in mental illness, par-ticularly in patients with manic depressivepsychoses. The study conducted by thedepartment was the first of its kind in thecountry on the manic depressive psychosis(MDP) patients. Such studies have beenhitherto carried on only in the advancedcountries. The results of the study alreadymade showed that the MDP patients.showedhighly abnormal .electrophysiologicalfeatures of sleep states. They had almost nodelta or the stage IV sleep and most of thesleep time was in the stages I and II (spindlesleep) and in the stage REM sleep. Anotherabnormality in them was the occurrence ofREM - sleep immediately following thewakeful state.The alpha was diffusely spreadand choppy. The autonomic nervous.indicators also were studied. A furthersubstantive study is planned for the future.

Research projects in neurophysiologyunder the joint protocol of the agreement inmedical sciences and public health signed bythe Governments of India and Soviet Union:

Under the above agreement, it has beendecided that joint researches on the subjectof neurophysiological basis of emotionalstress and resistance mechanisms have to beconducted. Two of the projects under thisagreernent require animal experimentation,and the third one is concerned with the studyof effects of yogic techniques on human phy-siology and their application for p..even-tion of emotional stress consequences.These projects are being planned to interactin the rr. Dst fruitful manner with the corre-sponding scientists of the Soviet side.

Other activitiesProf. T. Desiraju is functioning as the

editor of the Indian Journal of Physiologyand Pharmacology (IJPP).

tiREPII.A NS; the brain while the neurosurgical procedureA laboratory is being set up for doing is carried on the patients for treating

clinical neurophysiology for monitoring parkinsonism by Dr. R. M. Varma and'electrical signals of deeper parts of colleagues.

."%

Facilities for Studying neurophYsiologIcal changes of human brain and body ftinctions clu` ring yogicpranayamas, meditations, sleep-dream states, eta Subject is investigated in the sound-proofaircondit:oned cabin (A), by monitoring behaviour through closed-circuit television, EEG telemetry,Kirlian imaging, Polygraphy of various parameters, evoked potentials, on line control and analysis withcomputer (13); and studying metabolic rate (a..

Neurobhysiology facility (0 with 8) for monitoring human thalamic and basal brain neuronal electricalsignals during operation on a patient by percutoneous thalamotomy to treat parkinsonism.

The Department of Biophysics was re-opened in November 1974, after a gap ofalmost 10 _yew's, with the appointment ofDr. S. V. Talekar .as lecturer who initiatedresearch in-the field of biorinmbranes andcarried out some interesting studies on the`on selective permeability. With his demise in1981, the department suffered a great loss.

Subsequently, Dr. Viney Jain was appoin-ted as Professor. New laboratories for thedepartment were constructed and thedepartment shifted to the new premises inJune, 1984.

ObjectivesThe objectives of the department are : (i) to

carry out research in pure and appliedbiophysics with special reference to neuro-biology and mental health sciences, (ii) todevelop teaching programmes for training inbiophysical sciences, and (iii) to participate inthe institutional programmes for providingefficient patient care.

MANPOWER DEVELOPMENTThe department offers training to PhD.

students of the Bangalore University. A twoyear MPhil. (biophysics) course has beenapproved by the Bangalore University andwill commence from September 1986.

RESEARCH

NeurobiophysicsSelective ion permeability through mem-

branes playva central role in the generationand propagatim of nerve impulse. Theo-retical studies carried out in the departmentled to the formulation of a model whereselectivity is a function of the difference in theactivation energy for diffusion of ion in waterand that of the self-diffusion of water, thereby

arriving at a selective ion-current equation inwhich the property of negative conductanceis inbuilt`

Biomedical InstrumentationAn assembly (based on the filter trap

technique) was designed a'hd fabricated toincrease the capture of cellular or microbialelements in in-vivo diluted samples of CSF.This assembly can be useful for CSFanalysis in remote rural areas wherelab Iratory facilities are not available. (2).

Neuro:oncology

Cancer Prevention and Detection:Environmentally induced DNA damage andcapacity of its repair in the living cells,profoundly influence important biologicalprocesses like mutation, ageing, malignanttransformation and cell death (Fig. 11

Reliable data on genetic damage induced byenvironmental agents in mammalian,including human systems are needed todetect and identify environmental pollutantsand to arrive at correct estimates of risk. Tofacilitate this, we have developed flow-cytometric techniques for precise measure-ments of cellular DNA content and itsdispersion in human cell populations (3, 4).These automated techniques can providequantitative and objective information andare also useful in the diagnosis of braintumours (4, 5).

Theoretics' studies on tumour growth andresponse to treatment:

A simple mathematical model for tumourgrowth its perturbation by radiation hasbeen formulated to understand quantita-tively, the role of various repair and cellkinetic processes in determining theresponse of tumours to treatment. The

53

th9, sifr41:100 PP 4 Mcr9.4.9,rrOtei:and Atie5respdriSes to ,various radiationregimens can be :theoretically ealCulated.The agreement with the, experimental' data.pn transplantable tumours in labora- toryanimals is quite satisfactory (6, /). Thesestudies will be helpful in investigating theeffects of various radiation sensitizers and in

. -

formulating optimal radiation therapyregimens on a rational basis.

Use of 2-deoxy-D-glucose to differentiallyenhance radiation damage in brain tumours :Cellular repair processes are known torequire metabolic energy. 2-deoxy-D-glu-cose J2-DG), a gluCose analogue'. and aninhibitor of glycolysis, has been shown todifferentially inhibit repair of radiationdamage in cancer cells (8). Experimentscarried out on organ cultures of braintumours have shown that the frequency ofgamma ray induced micronuclei and DNAcontent dispersion increase significantly, if 2-DG is present for a few hours after irradiation(Fig. 2), The proposed Mechanism of action.underlying this phenomenon is schemati-cally shown in Fig. 3. These observationssuggest that administration of 2-DG could beused to enhance radiation damage andthereby improve radiotherapy of braintumours (9). Clinical trials to verify thispossibility are planned.

FUTUE PLANSMedical BiophysicsNeuro-oncology:Research work directed towards developingnew biophysical techniques for improvingtherapy of braitumours will be continued.In particular, emphasis will be to develop:(1) non-invasive techniques for monitoringquantitatively , and objectively the thera-peutic response in brain tumours, (ii) photo-therapy, using photosensitizing dyes andlight for treatment of brain tumours and

optimization of cancer therapy usingglucose analogues in combination withcytotoxic agents.

NeurobiophysicsBioenergetics and cybernetics of thenervous system:Energy metabolism plays a crucial role in the 13eferences p.ovided under "PubLattons of tfp staff"

,functiOning of the brain. Recent work hasshown that a very tight coupling existsbetween the energy yielding and energyconsuming processes in the nervous system.The underlying mechanism for this tightcoupling are not yet precisely known. Theaim of our work will be to investigate thesemechanisms and to study quantitatively therelation between the energy metabolism andvarious stages of information processing inthe nervous system in health and disease.During the first phase of this researchprogramme, suitable techniques will bedeveloped and studies will Se carried out invitro and in vivo modeL systems at variouslevels of organizatidn. Work on non-invasivetechniques to study the energy metabolismof living systems using 31-P NMRspectroscopy has been initiated for thispurpose (10).

Molecular and Cellular BiophysicsDNA damage and repair in neurological andmental disorders:There is considerable circumstantialevidence suggesting that a number ofneurological and mental disorders could becaused by defects in the DNA repair capacity.Accumulation of DNA damage may also berespOnsible for ageing. Research in this fieldhas been hampered because of lack ofadequate techniques for measuring DNAdamage and repair in brain cells. Therefore,suitable techniques to measure error-freeand error-prone DNA repair in various typesof brain cells will be developed. Relationshipsbetween chromatin structure, membranesand DNA repair and metabolism will bestudied. Attempts will be made to developmethods by which error-free DNA repaircould be enhanced. This could help inreducing the symptoms of the disease. IfDNA repair defects can be detected early, itmay be possible to even prevent thedevelopment of the disease.

76 54

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Fig 2(a) Effects of 2-DG and gamma-rays on (a) the micronuclei frequency and (b) DNA contentdispersion (C(V) observed' in organ cultures of human brain tumours.

Fig 2(b) Effects of 2 -DG and gamma rays on the (a) micronuclei frequency and (b) DNA contentdispersion (CV) observed in organ cultures of human brain tumours.

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Fig. 3 A siripIified model sho&iing the patthrns of energy suppl, and their mod jicauons Induced b 2deoxy-D-gtucose (2-DG) in normal and cancer cells. The cellular repifr processes are inhibited In incercells in the presence of 2.DG because of drastic reductlun in the rate of ATP production

78

Realising the scope of biostatistics in thefield of medical research in general and in thedevelopment of psychometric and biometricmethods in particular, the department ofbiostatistics was established in 1954.

ObjectivesThe main objectives of the Department

are to :Train the postgraduate students of this

Institute in biostatistical, computatical andresearch methods,

Provide consultative services on statisticalmatters to medical, biological anti behaviou-ral scientists,

Co-ordinate and standardize the collec-tion of medical statistics and other relevantinformation in this institute,

Provide a statistical basis for planningprogrammes designed to advance mentalhealth and neurosciences and.the well beingof the people,

Extend statistical service and assistance tothe institutions involving the study of mindand brain,

Develop a data bank for mental health andneurosciences,

Encourage research activities by intro-ducing computer oriented statistical methodology to analyse and interpret datapertaining to the field of mental health andneurosciences,

Encourage advanced research in bio-statistics particularly the statisticalproducers in behavioural and biologicalstudies. and

Develop a bank of relevant literaturepertaining to methods in psychometrics andbiometrics in terms of journals, books,reprinted research papers and index codes.

EquipmentThe staff of the department were using

computers installed at the Indian institute ofScience, Bangalore and Indian Institute ofTechnology, Madras for their analysis ofresearch data. The department acquired acomputer of its own in 1982.A SPECTRUM/7 with 64 K memory, four floppy disk drivel",CRT and dot matrix printer was added alorpwith a data entry machine SPECTRUM/31With 48 K memory and one disk drflie.SPECTRUM /31 was later upgraded withCRT and printer. A key to tape unit was alsoadded.

One MOSCAL 1185, an electroniccalculator with 1000 steps programmablefacility and 1000 steps data register, threeMOSCAL 1402 calculators (statistical) andfour COUNT 06 PPD electronic calculatorswere also obtained for use in the statisticallaboratory.

MANPOWER DEVELOPMENTThe staff of the department have been

teaching one full paper in Methods of ClinicalResearch to the students of M.Phil. in Medicaland Social Psychology, one full paper inMethods of Social Work Research forstudents of Psychiatric Social Work and partof a paper in Biostatistics to students of M.D.and D.P.M. in Psychological Medicine. Everyyear lectures are offered to the trainees inD.M., M.Ch. and PhD.

Along with lecture schedules in thetheoretical and applied statistical methods,practical classes were introduced to thestudents of M.Phil. courses in Medical andSocial Psychology and in Psychiatric Socialwork.:The syllabus for the above.courses wasrevised more than once during the lastdecade to suit to the modern trend in

577 79

`reSearchtriethOcIS'and applied statistics.

Consultancy ServiceStatistical consultations and services have

been offered to the students for their coursestudies and to the staff in their research work.During the last ten years 27 PhD. th6es, 53M.D. theses, 7 D.M. theses, 6 M.Ch. theses, 22D.P.M. dissertations and 98 MPhil.dissertations were assisted by thisdepartment.

Consultancy and Service to otherProgrammes

As part of the National Mental HealthProgramme, the ICMR has sponsoredseveral multi - centre projects at NIMHANS.Of these for three' multi-dentre projects Mr.V.G. kaliaparumal has been appointed asthe Statistical co-ordinator. The followingthee'' projects hive been successfullycompleted:

1. Evakiatiol of the training programme oftraining the non-psychiatric doctors inpsychiatry.

2. The pattern of child and adolesdentpsychiatric 'disorders.

3. Severe mental morbidity survey, andintegrating mental health programmeIntO the general health care.

RESEARCHThe staff of the department are Involved in

a number of research projects of the clinicaldepartments. One major research projectwas on 'The seizure prognosis of patientswith epilepsy" which resulted in developing anumber of models to predict seizureoutcome for patients with "Primarygeneralized seizures" "Simple partialseizures" and "Complex partial seizures".Models were developed for each of threegroups and also fcr the aggregate group."LongTerm",. "Medium:Term" and "Short-Mire prognosis were considered. Further-more, an Index of Improvement" was ,alsodeveloped. ,A number of multivariatestatistical" rnethodS such :as,. MultipleRegression Analysis, Simple nd MultipleDiscriminant Function Knalys:c,, ClusterAnalysis, Principal ,component Analysis,

Factor Analysis and Pith CoefficientAnalysis were employed together withunivariate statistical methods. The followingis one of the prediction models developed :

Model to predict long term prognosis of patientswith epilepsy

Predictors Scores

Regular medicationRegular for four years 3.172Regular for three years 2.379Regular for two years 1.586Regular for one year 0.793 "Irregular 0.0

SexMale 1.039Female 0.0

Autonomic phenomenaPresent 1.5Absent 0.0

No. of attacksTwenty or more 0.861Less than twenty 0.0

Decision Rule:If the sum of the score is 2.9 or more the patient is

deemed to be in good prognostioclass. The uncertaintyIn the decision is 24.0 per cent.

Hospital StatisticsDuring the last one decade in particular,

hospital statistics have been compiledperiodically. From 1980 onwards, detailedinformation about in-patients, viz., date ofregistration, date of admission, age, sex,income, religion, education, occupation andoutcome of admissions have been com-puterized. Computerized data are alsoavailable for the outpatients regarding basicdemographic variables. Detailed information on deaths In the hospital is alsocomputerised.

Computer UtilityA number of programmes have been

developed for multivariate and univariatestatistical analyses to use with SPECTRUM// and SPECTRUM/31 computers. Severalsubroutines along with other programmes instatistical analysis have been developed.

The addition of a computer to the de-partment added more facility whichstimulated more and more research projectsand sophisticated statistical analysis. This

CO:n0Otei lilpeing Used...by in-Ofe than, tWentyProjeCtstaff;

:StUdentS, staff and. all research 'projectStiff are using the comPUtetthroughout theyear Theiels an urgent needlor a bettercomputer with large memory and multi.terminals, tape drives and 'line printers.

Attempts are 'being made t& computerizelibrary information and accounts of theInstitute.

Application of multivariate statisticalmethods for a number of PhD. and MD.theses is enabled with the installation of acomputer in this department

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Cytogenetics:

The study of genetics in unravelling thehereditary disease is an important subject,specially in the field of mental health andneurosciences. Human genetics plays a keyrole in establishing 'etiological and chwac-terization of the disease or defect. Since aMental Retardation. Clinic is run pn a specificday at NIMHANS, the registry of 1,000 to1,200 new cases per year and nc aiy 100other familial psyChiatric and neurol- 'caldisorders are referred from other disciplines,genetic investigation is necessary for properdiagnosis of the case. Most of the subjectswith mental retardation and other familialdisorders arc worth studying for cytogeneticinvestigations' and thereby to some extenthelps in establishing the etiology of thedisease. Keeping in view the need of thediscipline of genetics in mental health inorder to cater to the needs of teaching,research and training in human cytogenetics, the department of cytogenetici wasestablished during 1983-84.

The objectives of the department are: (i)To carry out a systematic cytogeneticinvestigations and to record chromosomalanomalies in various syndromes; (ii) Toestablish the etiological factors in causationof the diseases, (iii) To utilise the availableinformation for purposes of geneticcounselling, (iv) prevention of mentalretardation and management of the men-tally handicapped and (v) To carry outcytogenetic investigations in some of themalignant brain tumors for characterisation.


The department is actively enaged inteaching the basic aspects of genetic arathefield of human cytogenetics for the postgraduatt. students of other disciplines. TheresuL of the cytogenetit. instigations areused kr discussions curing the caseconferences and presentation.

It is planned to conduct journal clubreviews, seminars pertaining to the field ofhuman cytogenetics for updating the recentinformations accrued.

FACILITIES

The Department is equipped mostrecent and sophisticated equipments toconduct researches in the field of humancytogenetics. Provisions are also made forstudying the routine chromosomal analysis,prenatal diagnosis, durnatuglyphic studiesand studies on the cytogenetics of malignantbraiii. tumors. The department has facilitiesfor cell culturt. studies also.

SERVICESThe cytogenetics laboratory is providing

diagnositc services for the referrals fromMental Retardation Clinic and for otherfamilial neuropsychiatric disorders.

RESEARCHResearch on the following areas of

interest is on hand :

1. Cytogenetic investigations of the mentally retarded and in other familial neuro-psychiatric disord--5.

2. X linked men',.. .aton (MR) amongthe unspeclied group of M R subjects.

3. Studies concerning the dermatoglyphicpattern of the cases for correlation withthe genetic findings.

FUTURE PLANSExpansion of activities on the following

research programmes are envisaged.

(i) Providing prenatal diagnostic servicesfor the families having a high risk ofrecurren, Jf the disease, (ii) Cytogeneticinvestigations in malignant brain tumoursand its characterisation, (iii) Understandingthe genetic mechanism in some neuro andpsychiatric disorders.

3 2 . .

Central Animal Research Facility (CARF)

The animal research laboratory came intoexistence in 1980, largely due to the effortsof Dr.T. Desiraju, who strived hard to bring itup. It-has been designed in consultation withleading institutions sucl- as Indian Institute ofScience, Bangalore and National Institute ofNutrition, Hyderabad. It has been function-ing as a central facility for all the departmentsof the institute providing opportunities foranimal research work.

ActivitiesApart from maintenance of laboratory

animals and birds, the CARF provides allfacilities and assistance to the researchers;ofvarious departments. A total of 8 depart-ments which include Neurophysiology,Neurochemistry, Neurology, Neurosurgery,Neuropathology, Psychopharmacology,Microbiology and Neurovirology areutilising the facilities provided by the CARFat present. Various other departments arecoming forward requesting space. TheCARF has also been supplying animals (ratsand guinea pigs) to some institutions inBangalore and elsewhere in the country on anon-profit basis.

The year-wise distribution of the variousanimals and birds being maintained in theCARF since its inception. is indicated inTable-1.

Facilities AvailableThe facilities available at the CARF

include a room housing a balance accessibleto all workers; a refrigerator, a dissectiontable, and surgical instruments, facilities forstar ~' - a microscopy, steam sterilization,incineration, and preservation of carcassesin a deep freeze. A biorythm room is beingconstructed for common use. to enablebehavioural studies of rats. Funds to

construct another floor have been sanc-tioned in the Seventh Five Year Plan forproviding more facilities.

Primate UnitOver the past five years a total of 130

bonnet monkeys have been procured by theCARE These animals were used for mal-nutrition and development studies andneurotoxicological studies by the depart-ments of Neurophysiology and Neuro-chemistry respectively. Eleven animals wereborn in captivity due this five year period.

Small Animal UnitTo start with, this unit was housing only

Wistar strain of rats and Swiss albino mice.Later a number of other species such asrabbits, guinea pigs, golden syrian hamsters,cats and sprague-dawley strain of rats wereadded on to tbi.5 unit. These animals arebeing used for malnutrition, behavioural,toxicological, oncopathological and im-mmological purposes by various depart-ments. In addition some of them are used forpractical demonstration classes of studentsby the departments of neurophysiology andneurosurgery.

KennelAn improvised kennel to house 10 dogs

was established in 1984. The departments ofneurophysiology and neurosurgery areusing these animals for the purposes ofpractical demonstration and experimentalsurgery respectively.

A new kennel with facilities for anoperation theatre and post operative careunit is being planned.

AquariumThis has facility to house fishes, frogs and

g ;61 3

tadpoles. However at present only frogs arebeing niaintaineci. They are used by thedepart ments of neurophysiology, neuro-chemistry and neuropathology for variouspurposes.

Birds'Ducks are being maintained in the

CARF collecting red blood ce:ls for use indiagnostic virology. Chick embryos are alsobeing maintained for certain arterio-venousmalformation studies being conducted bythe department of neurosurgery.

Table 1Toted No. of Animals maintained at the Central Animal Research Facility

Animals

1. Rats2. Hamsters3. Mice4. Guinea Pigs5. Rabbits6. Cats7. Dcqs8. Monkeys9. Ash

10. Frogs11. Lizards12. Ducks13. Chicken

No. of A dimals198 1981 1982 1983

41 251 502 128624 86

39. 27 32 7103 12 16 1120 24 44 3302 24 29 1504 0202 29 23 48

1984 1985

1486555401145

20514864

8

62

180712

1051230222161

233240201

Library aholinformation Services

The Library and Information Services,started with the establishment of the AllIndiaInstitute of Mental Health has been plannedto collect, preserve, disseiinate andexchange information required for theprogress in the field of the mental health andneuro-sciences all over the country.

The library has grown in size and scope ofservice in consonance with the Institute itselfin the last ten years. Being the library of theNational Institute in the area of mental healthand neuro sciences, it has an importantresponsibility of building up a strongdocument collection base, in order to ensurethe availability of one copy of everyworthwhile publication in mental health andneuro sciences published anywhere in theworld.

In the last ten years, the number ofjournals subscribed to has increased to 305.About 1500 volumes are added every year.The special collection includes books onIndian philosophy, Yoga, Upanishads.Tantric& Mysticism, Indian medical system andepics besides books in the differentdisciplines of neuro sciences. The richcollection of the ;Ibrary continues to be usednot only by medical, paramedical, andscientists of the Institute, but also by a largenumber of scientists and researchers fromseveral parts of the country.

In order to supp' ,ment the libraryresources, regular cc...,aboration has beenestablished with many international librariessuch as National Library ofMedicine, U.SA.,National Institute of Mental Health, U.SA.,National Institute of Alcoholism and DrugAbuse, U.SA., National Translation Centreand World Health Organisation, Geneva. Alarge number of publications from theseorganisations are being received regularly.P.

83,1

number of back volumes of journals arebeing received through the ExchangeScheme of Medical Library Association(USA). Many journals are also being receivedin exchange for NIMHANS JOURNAL.

Prof. T. K. S. lyerpjar, Librarian, IndianInstitute of Science, has helped for thedevelopment of this library as a Consultantand Chairman of the Library Committee. Ablueprint of 4 computerised NationalInformation Centre, in the field of mentalhealth and r1P .o sciences, .vas proposed.This information service has the objective ofsupplying latest information to all specialists,scientists and reseachers working in this areathroughout the country. The plan is underactive consideration.

The expanded services developed in thelast ten gears are: (I) Reference Service,(if) MEDLINE Searches (with the assistanceof W.H.O.), (iii) Bibliographic Service,(iv) Reprography Service, (v) Inter-LibraryLoan. and (vi) Reprint Procurement.

The reading room provides biomedicalreference and is intended for the use of pro-fessionals, students and research workers.Control and circulation section is identifyingand retrieving materials required by thelibrary patrons and also on Inter- Libraryloan. The library has co-operative arrange-ment with many other libraries in and outsideBangalore and assists in procuring photoco-pies of papers in India and abroad.

Now, the library has automatic photo-copying machine, micrc film-cum-micro-fiche reader, electronic scanner and electronic typewriter.

FUTURE PLANSDevelopment of National Information

85

Publications

An integral part of any research/serviceinstitution is the publication activity.PubliCations have become inescapablecomponents of the working of all institutionsin general and research and serviceorganisations,in particular.

In furtherance of the objectives of under-taking publication of journals, research mo-nographs, leaflets and textbooks, collecting,organising and publishing knowledge aboutmental health and neuro sciences enshrinedin the Memorandum of the Association,efforts were made to rejuvenate publicationactivities soon after the emergence of theNational Institute in 1974. Severalprocee Lags of international and nationa:seminars and cor;erences were brought out.

As a further step in the development of thepublication activities, a separate departmentof publications came into being with the ap-pointment of the assistant editor in Decem-ber 1981. As a logical step, a systematicprogramme of publication comprisinginformation booklet for visitors, newsletterfor internal communication, journal forresearch communication, annual reportsand proceedings of international andnational conferences and seminars wereinitiated. Annual Reports, NIMHANS NEWS(fortnightly), Calendar of Events (annual) arebeing published regularly since then. Severalproceedings of seminars/symposia held atthe Institute have been published, a list ofwhich is given at the end.

NIMHANS JOURNAL was started inJarwary, 1983. It carries papers i the flexd ofmental health and neurosciences in its broa-dest sense.The journal :,:nce its inception hasbeen coming out exactly on the cover date. Itib being published in January and July every

year. At present, it is in its third volume.Subscription is increasing, exchange of otherjournals is enck aging and contribution bythe faculty of the Institute is overwhelming.Encouragement by professionals andresearch workers elsewhere is prompting usto increase its periodicity in the near future.

In order to cater to the ?oval communityalso, efforts are being made to publishliterature on mental health in Kannadalanguage. In this direction, a book on 'Mindand Mental Illhealth' a collection of popularwritings in Kannada has been brought outand is being made available to thoseinterested at a subsictsed cost. Keeping inview the multi - disciplinary approach of theInstitute, publications of varied nature arebeing ventured.

Expanding of publication of litere-ire onmental health, publishing popular books forthe benefit of the common man are planned.Establishing a separate Mental HealthExhibition for the visitors is also envisaged.

. 6b87 015

Medical Illustration and Audio Visual Aide

Medical Photography Unit as it was initial-ly known, was first instituted in January1955. It was a section by itself and mannedby a photographer. To improve the service,the unit was placed under the guidance of theneuropathology department in 1974. Sincethen, . the technical staff has increased. Asenior photographer,. an artist and a darkroom assistant are working and the unit hasbeen renamed as Medical Illustration andAudio-Visual Aids Unit. The unit is geared toprovide modem medical teaching aids byway of photography and artistry. It isequipped with Bolex super 8 mm and Lolex16 mm reflex cameras for movies andAshahi Pentax 35 mm and Mamiya 120 mmcamera for still photography. Ashahi andMamiya cameras have tele and wide angleand close up lenses. Excellent quality deve-

a IP

loping and printing is possible in the adjoin-ing lab, where an Agil 35 mm enlarger andIllford strip printer are used. The studio hasan umbrella flash light to avoid shadowswhile capturing clir.lcal photographs.

The unit caters to the needs of all thedepartments in the Institute and covers allofficial functions. It also undertakesscreening of cini and clinical movies forpatients and staff of NIMHANS. The photoartist provides adequate help for exhibitingclinical material by way of charts and slidesat national and international conferences.

It is proposed to acquire a VCR unit as wellas equipped lab for colour 'In processing,for proper documentation of clinicalmaterial.

Studio with umbrella 166'

Biomedical Engineering Section

Biomedical engineering is an emergingfield which is concerned with application Ofengineering technique and principles toMedicine and biology. NIMHANS is one ofthe few institutionsWhich has taken lead toestablish this department. Although thisdepartment was formally established in1982, clinical engineering works of thehospital and the Iristitute werebeing done bya central workshop since 1964 and the same,was merged with this department on itsinception. Necessary infrastructure for thedevelopment of the department wereprovided. Additional accommodation wasprovided over the old workshop building toset up a modern instrumentation laboratoryand all basic electrical and electronic testingand measuring instruments and allmachineries for the mechanical workshopwere procured. In addition to the bio-engineering activities, this department hasbeen asked to take up the clinicalengineering works also, with the followingobjectives :

To design and develop hardware andsoftware instruments to support researchand clinical programmes.

To familiarize the application of electronicand instrumentation techniques for medicalprofessionals.

Repair and servicing of electronics,electrical and electro-mechanicalinstruments and equipments.

Manufacturing and upkeeping of allfurnitures of the hospital.

Regular calibration of the equipments asper specifications and international safetyrules.

To keep accessory, spare parts, circuitdiagrams, operational manuals, service manuals, etc.

67

it (..)

This unit, acts as liaison between purchasesection and other departments and also findsout providing the servicing facilities, spareparts, circuit diagrams etc., to other depart-ments.

A separate annual budget has beenallocated for the procurement of spares,components and equipment for the mainte-nance and servicing works.

SERVICESA number of development projects in the

area of medical electronic instrumentation incollaboration with various departments havebeen taken up two specialised hardwareinstruments have been developed to studyrespiratory muscle coordination and im-pedence measurements during ECT.

Preventive maintenance and safetydevices have been introduced for all theequipments as a compulsory measure andstrictly followed to avoid frequentbreakdown. 450 KVA servo controlled 3phase voltage stabilizers have been installedin the power house of the Neuro Centre andthe Institute building to avoid surge andfluctuations in the power supply system.

Repair and maintenance of all electricaland electromechanical items like autoclaves,medical air compressors, mechanisedlaundry machines, boiler, central suctionpump etc. were carried out, whichconsiderably reduced the down time andmaintenance cost.

Servicing and maintenance ofrefrigerators, window airconditioners andwater coolers are also a part of the additionaltask of this department. Over the years, quitea large number of damaged furniture likesteel cots, almirahs, trollies, steel table

89

frames, lockers, screens, stands, chairs /ererepaired.

BP apparatus, laryngoscope, ophthalmo-scope, stethoscope and diathermy units,respiratory ventilators,, radiological equip-ments are being maintained tot.. p improvethe patient care.

MAN'clOWER DEVELOPMENT

The Instrumentation laboratory offersshort term practical training course ondesign, development and maintenanceaspects of medical instrumentatiori tovarious engineering college students.

FABRICATIONS & MODIFICATION

About 400 spring cots of psychiatricwards have been modified into sheet cots tosafeguard the cushion mattresses. All thestretcher trollies were modified into a moreconvenient trolly with cycle wheels and veryhigh quality, roadworthy castor wheels foreasy movements. /

Almost all the cots in the neuro wardswere fitted with new type of wheels to movethe patients from ward to operation theatre,radiology department etc. Now, they aretrouble-free and most convenient

Engineering Section

The engineering and maintenanceactivities of the erstwhile Mental Hospitaland AIIMH were looked after by KarnatakaPublic "iorks Department and CentralPublic Works D epartmenfrespe ctively. A fterthe integration of the Mental Hospital andAIIMH and formation of NIMHANS,' aseparate engineering section was opened.All the construction works are undertakenunder the supervision of the Building andWorks Committee headed by the ChiefEngineer (Construction & Buildings) of theGovernment of Karnataka. With severalbuildings added in recent years, and manyothers coming up, the institute's campus isgrowing in length and breE.dth.

For the last ten years, several importantbuildings have come up. During 1980, thefirst floor over the occupational therapy andrehabilitation (Oar)) building, en nurseshostel and a building to accommodatelaundry services were constructed. The firstfloor over the men's hostel was built in 1983.

In order to cater to the needs of thein,reasing out-patients, a separate neuro-psychiatric out-patient building at a cost of83 lakhs in under final stage of completion.This modern building spreads over an areaof 14 acres. The need for additionalpsychiatric special wards were felt andaccordingly two-floor psyL:iiatric specialwards building with a bed strength of 70 wascompleted during 1985.

Establishment of several flew depart-ments necessitated additional spacerequires Tents. In order to provide adequatespace to the departments of biophysics,biostatistics a id to house the departments ofcytogenetics, psychopharmacolopy andneurovirolcgy, the second floor over theadministrative block was built.

Efforts to provide residential q' garters to asmany staff as possible are made. Apart fromthe quarters built in the previous years, 4 nos.of type I, 10 nos. of type IV and 8 nos.of type V quarters were constructed duringthe period. Residential accommodation iselso being provided in the newly allottedlands near Byrasandra.

WORK IN PROGRESS .

An extension of the OCTD building isnearing completion. Construction of secondfloor over the special wards in the NeuroCentre and a 0.2 MG overhead water tank isin progress. The work of providing sc andproof facility to the ENMG laboratory isnearing completion. Another 92 quartersare under construction.

FUTURE PLANSConstruction of the new library and

information services block, an auditorium,common laboratory in the administrativeblock, mortuary building ar.d lad:,s hostel,are being undertaken.

69

Ayurvedic Research

The Ayuryedic Research Unit of the Cen-tral Council for Research in. Ayurveda andSiddha, has been functioning at NIMHANSsince 1971 with the Director of NIMHANSas its ProjectOfficer. This unit is manned byayurvedic physicians, p.cchiatrist, clinicalpsychologist, statistician and other parame-dical and ministerial staff. It is engaged inunderstanding and examining the role ofayurvedic system in treating differentmanasa vikara (psychiatric illnessess). In pur-suance of this goal, the Unit has been con-ducting studies on various aspects of manasavikara on the basis of their descriptions in theayurvedic classics. Recently the Unit has alsotaken up, studies on certain neurologicaldisorders.


Lectures are being delivered on differentaspects of 'Monza roga (mental disorders)described in Ayurveda' and on the activitiesof this unit to the house surgeons deputedfrom the Govt. Colleges of Indian Medicine inKarnataka, students of the Nursing C011ege,Bangalore, and foreign scholars and visitorsfrom time to time. Periodical orientationlectures are delivered for the benefit offaculty -nmbers and residents.

SERVICESBesides' the studies. Oursued;' 'the Unit

offers general clinical services to the patientssuffering from different mental disorder;who opt for ayurvedic treatment. In additionto regular out patient service, in patients with40 beds are available. The clinical servicesare :.2Is7 provided to the staff of the Unit andthe NIMHANS.

STUDIES

BrahmyadiyogaA double blind controlled study of Brah7

myadiyoga and Tagara in the managementof acute schizophrenia (various types ofunmada) has been done during 1973-74.Brahmyadiyoga is a herbal compoundcontaining Brahmi (Centella asiatica), Vacha(A corus calamus), Jatamamsi (NardostachysJatamams0, Kustha (Saussure., lappa), Sar-pagandha (Rauwolfia serpent:. ,a) andTagara(Nymphoides macrospermum). The effect ofthis compound anc; the single drug Tagara,were compared with that of Chlorpromazineand a Placebo. Twenty-sevIn patients werestudied under each group.

It was found that Brahmyadiyoga was sig-nificantly better than Placebo and Tagara inreducing morbidity. Tagara was not very ef-fective. Chlorpromazine was significantlybetter than Placebo and-Tagara. Although itwas superior to Brahmyadiyoga, the differ-ence was not statistically significant.

Ksheerabala TailaA controlled study on the role of Ksheera

bala taila in psychogenic headache (Vatajashirahshoola) was carried out during 1973-77. Fifty -six patients (28 in Ksheerabala tailagroup and 28 in placebo group) sufferingfrom psychogenic headache were studic,o.Ksheerabala taila was used in 28 cases in theform of pana consumption) nasya (nasalinstillation) ane. sniroabhyanga (anneling onhead), for six weeks.

During the period of treatment, the Ksheerabala taila treated troup registered impro-

92

vement more than the placebo treatedgroup: There was also significant reductionin the anxiety syndrome in the ksheerabalatreated group but no significant differencewas noticeable in depression syndrome.

UnmadaA preliminary study on laxanasamuc-

chalk! (symptomatology) of unmada(psychosis) was done in 1975. In this study,an attempt was made to understand thepossibility of diagnosing unmada on thebasis of lakshana and doshadusti (dosicimbalance) and the psychiatric diagnosis ofmental disorders.

One hundred cases of unmada werestudied. There was a high agreementbetween the two ayurvedic physicians bothon diagnosis and symptoms. But there wasno correlation between ayurvedic andpsychiatric diagnosis.

Shirolepa

A pilot study onShiro/epa(head plasier) inpsychotic excitements was conducted in1975. A herbomineral compound powdercontaining powers of Amalcki (Embalicaofficinal's) deseeded dry fruit, Sarpagandha(Rauwolfia serpentina) root, Khaskhas(F'apivera somniferum) dry seeds and Garika(red orchre) mineral, was used in the forth ofa paste (made with rose water, which servedas a binding agent) for dplying on the vertexin patients suffering from various kinds ofpsychotic excitements. The thickness of eachapplication was for 0.5 cm. Five applicationswere made por day on the average. Thechange was observable in 20 to 40 minutesafter application.

Out Df 231 applications, 141 broughtabout calming effect and it was observed thatthis application was effective in bringingdown moderate degrec of excitement inpsychotics.

Anavonmada

A pilot study on the idle of Brahmya-diyogp in chronic schizophrenia (anavon-mada) was done between 1975-76. Brah-myadiyoga a-herbal compound formulatedby the Unit was orally administered in theform of tablets in doses 6, 12 and 16 gm inthe first, second and third months respective-ly for a period 3 months. Of the 14 selected,only 10 took treatment for more than 3months and of them, 7 improved. The otherfour who took treatment only for two monthsalso improved

A double blind controlled study on the roleof Brahmyadiyoga in anavonmada wasmade in 1979.82.

In this, 65 chronic patients suffering fromschizophrenia were studied. Of them 23 be-longed to Brahmayadia (BRY) group, 22to Chlorpromazine (CPZ) group and 20 toPlacebo (PLB) group. The drug adminis-tered to each patient was 75 days.

The study revealed that BRY is better thanPLr, although CPZ was significantly betterthan both BRY and PLB. It was concludedthat BRY could be considered as fairly depen-dable ayurvedic drug for a general ayurvedicpractitioner.

KsheeradharaKsheeradhara in anxiety neurosis (chittod-

vega) a pilot study was conducted during1976-78. Ksheeradhara is a treatment givenby streaming medicated milk obtained byboiling the milk with certain herbaldecoctions on the forehead of the patient,daily for 14 days.

This was administered to 10 patients whosuffered from anxiety neurosis for more thansix months and did not respond to allopathictreatment of at least 3 months duration.Their periodical assessments were made byayurvedic physician, psychiatrist and clinicalpsychologist Of the 10 patients 8 improved,

71 93

and the improvement was statistically highlysignificant.

Ayurvedic Treatment in Unmada

A retrospective study on the general lineof ayurvedic treatment in unmade. (psy-chosis) was conducted during 1977. Underthis study, 182 cases treated with general lineof ayuivedic treatment from 1972 to 1976were re.riewed. They had been given bothdosphapratpaneeka (anti-doshic) and uyadhipratyaneeka (anti-dis6ase), medicinesdepending on their conditions. Supportivetreatments like uirechana (puigation), ab-hyanga (anneling), basti (enema); nasya (na-sal- instillation), shirolepa (headplaster) etc.and drugless measures like bhajana (prayer),chankramana (strolling), kreeda (play) wereadministered wherever possible and neces-sary.

Of the 182 cases showed much improvement, 99 showed improvement, 47showed slight improveinent and others ei-ther did not improve o; left against medicaladvice.

The findings proved that the general lineof treatment is significantly effective in themanagement of various types of unmada. Itwas observed that 66% of the pationts hap-pened to be cases of dwandwaja unmadawhich is not described in the texts.

Mental ExaminationAn approach to mental examination

based on ayurvedic concepts was done cur-ing 1978-79. A modified scheme of mentalexamination based on the definition ofunmada by Charaka and the descriptionsavailable in the chapters on dinacharya (dailyregimen), ritucharya (seasonal regimen)'andsaduritta (code of virtues) has been preparedand published in the form of rnonograph.

This is folind very useful in the study of va-rious manasavikara on ayurvedic lines and isexpected to be of immense use to the ayur-

vedic scholars, researchers and general practitioners in the understanding and manage-ment of difiaent mental disorders.

Abhinyasajwara

Under the priority programmes, a servicecum research project on Japanese Encephalitis was taken up in collaboration with theRegional Research Centre (CCRAS), Bangalore, in November December, 1979. Ari ini-tial camp for 3 weeks and later fortnightlyservices were carried out at Chintamani,Kolar District.

Fiftyone encephalitis striken childrenhave been treated by the team. Of them, se-venteen recovered completely and thirty-twoimproved with residual deficits. Two casesdied during treatment in the acute phase ofthe illness. Eight of these children exhibitedpsychiatric symptoms. Visual and auditoryhallucinations, mutism and extreme fed:were predominant symptoms during theacute phase. In the reshlual phase truancy,stubbornness and decreased learning abilitywere observed.

Five of these eight have recoveredcompletely and the remaining showedmarked improvement when seen six monthsafter the onset of the illness, followingtherapy with ayurvedic drugs comprising ofcertain herbal as well as herbomineralpreparations administered both internallyand externally.

Studies in progress

1. Role of certain ayurvedic drugs inuncontrolled epilepsy (apasmara4.

2. Role of Ayushman-8, a herbal compoundin mental retardation.

3. Further studies on lakshana samucchayaof unmada.

4. Role of certain ayurvedic herbs inParkinson's disease (kampavata).

5. Role of certain ayurvedic drugs in themanagement of anxiety neurosis(chittodvega).

6. Role of apurvedic treatment in the acutely

ill patients with schiophrenia (unmada).

7. Pilot study on the role of certainayurvedic drugs in the management ofmajor depression DSM :if

. ,

`-lifiaiiihcisit;ecia.(steaM sedation)

Shirodhara (steaming medicinal fluids on the head.

C 73 95

FACULTY MEMBERS

Dr. G. N. Narayana Reddy, Director and Professor of NeurosurgeryDr. R. M. Varma, Emeritus Professor of Neurosurgery

Department of PsychiatryDr. S. M. Channabasavanna

Dr. H. S. NarayananDr. P. S. GopinathDr. R. Srinivasa MurthyDr. C. SharnsundarDr. K. N. SrinivasDr. N. JanakiramaiahDr. Mohan K. IsaacDr. Rajat RayDr. Ravishankar PandeyDr. V. ShivaprakashDr. C. R. ChandrashekarDr. Satischandra GirimajiDr. S. K. ChaturvediDr. Nimesh G. DesaiDr. Shoba SrinathDr. B. N. GangadharDr. R. RaghuramDr. Somanath Chatterjee

Department of NeurologyDr. M. Gourie DeviDr. H. Sathyanarayana SwamyDr. D. NagarajaDr. P. Satish ChandraDr. Suresh Rao AroorDr. Arun Kumar 13. Taly

Department of NeurosurgeryDr. Bhaban1 Shankar DasDr. V. K. JainDr. A. S. HeideDr. K. S. Narayana SwamyDr. B. A. Chandramouli

Department of NeuropathologyDr. Sara la DasDr. S. K. ShankarDr. T. Vasudeva Rao

Department of MicrobiologyDr. A. Chandramuki

Dr. B. N. Gokul

Department of NeuroanaesthesiaDr. G. Parameshwara

Dr. R. RamaniDr. G. S. :Ima Maheshwara Rao

Professor and Head of the Dept. ofPsychiatry and Medical SuperintendentAssociate ProfessorAssociate ProfessorAssociate ProfessorAssociate ProfessorAssistant ProfessorAssistant ProfessorAssistant ProfessorAssistant ProfessorAssistant ProfessorAssistant ProfessorAssistant ProfessorLecturerLecturerLecturerLecturerLecturerLecturerLecturer

Professor and Head of the DepartmentAssociate ProfessorAssistant ProfessorAssistant ProfessorLecturer in Paediatric NeurologyLecturer

Professor and Head of the Departme:-*Assistant ProfessorAssistant ProfessorLecturerLecturer

Professor and Head of the Departn.cmtAssociate ProfessorLecturer

Associate Professor and Head of theDepartmentAssistant Professor

Associate Professor and Head of theDepartmentAssistant ProfessorLecturg6

74

Department-of Neuro RadiologyDr. B. Y. T. A rya

Dr. P. N. Jayakumar

Department of NeurophysiologyDr. T. DesirajuDr. B. L. Meti

De:artrnent of Clinical PsychologyDr. G. G. PrabhuDr. K. SathyavathiDr. (Mrs) Malavika KapurSri. P. Madhu RaoDr. V. KumaraiahDr. C. R. MukundanDr. Haripada MishraDr. S. V. NagalakshmiSri P. KodandaramSri S. RamachandraMr. Craig Joseph GonsalvezMs. Kiran RaoMs. Nomita VermaDr. (Mrs) Shobini Lalith Kumar RaoDr. J. P. Balodhi

Dr. Satwanth Pasricha

Department of Psychiatric Social WorkDr. I. A. SheriffDr. R. S. BhattiDr. V. Nageswara Rao-Sri M. Ahmed BeigSri R. ParthasarathiSri M. RanganathanDr. G. Nardev

Department of NeurochemistryDr. B. S. Sridhara Rama RaoDr. K. Tharanath ShettyDr. M. N. SubhashDr. G. Y. C. V. Subbalakshmi

Department of BiostatisticsSri V. G. Kaliaperumal

Sri D. K. SubbakrishnaDr. Sanjeev Balwant SarmukaddamSri M. Venkataswamy Reddy

Department of BiophysicsDr. Viney Kumar J.einDr. K. Bhaumik

Department of Speech, Hearing andSri. M. N. Nagaraj

Associate Professor and Head of theDepartmentLecturer

Professor and HeadLecturer

Professor and HeadAssociate ProfessorAssociate ProfessorAssistant ProfessorAssistant ProfessorAssistant ProfessorAssistant ProfessorLecturerLecturerLecturerLecturerLecturerLecturerLecturerAssistant Professor,and SanskritLecturer in Clinical

Professor and HeadAssistant ProfessorLecturerLecturerLecturerLecturerLecturer

of the Department

of the Department

Indian Philosophy

Parapsychology

of the Department

Professor and Head of the DepartmentAssociate ProfessorAssistant PrOfessorLecturer

Aszlciate Professor and Head of theDepartmentAssistant ProfessorLecturerLecturer

Professor and Head of the DepartmentAssistant Professor

LanguageLecturer and I/C Head of the Department

75 97

Department of Psychiatric NursingSmt. K. Reddemma

Sri I. V. H. GeorgeSmt. K. LalithaSri H. M. Gangadharaiah

Departmebt of PsychopharmacologyDr. N. PradhanDr. Chandrashekar K. Mayanil

Department of Neuro VirologyDr. V. Ravi

Department of Physical Medicine andDr. P. S. Gopinath

Dr. B. S. Padankatti

Assistant Professor andChief Nursing Officer VCLecturerLecturerLecturer

Associate ProfessorLecturer

Lecturer

Rehabilitation ServicesAssociate Professor of Psychiatry andVC Head of the DepartmentAssociate Professor

Dr. Y. Ram Mohan

Dr. J. Suresh ChandraSri G. LakshmannaSri N. GopalakrishnaSri H. S. Siddamallaiah

Administrative StaffSri M. S. Vasudeva MurthySri T. A. SrinivasanSri M. N. RukmasaSri Y. S. Keshava MurthySri C. Radha Krishna

Engineering DepartmentSri H. K. RangaswamySri S. M. ParameswaraiahSri D. Harishkumar

Honorary ConsultantsDr. T. B. Basavarajendra

Dr. K. R. Murthy

Dr. C. Vittal

Dr. V. HemalathaDr. a G. BenakappaDr. A. MahadevaiahDr. C. MadaiahDr. H. K. Srinivasa Murthy

Ayurvedic Research Unit (CCRAS)Dr. M. G. RamuDr. B. S. VenkatararnMrs. Hemalatha Mukundan

Senior Research Officer,Electron MicroscopyVeterinarianBiomedical EngineerAssistant EditorSenior Librarian

Administrative OfficerAccounts OfficerAsst. Administrative Officer (H)Asst. Administrative Officer (A)Asst. Administrative Officer (S)

Asst. Executive EngineerAsst. Engineer (Electrical)Asst. Engineer (Civil)

Hon. Consultant in Medicine andChairman, Medical Board, NIMHANSHon. Consultant in Ophthalmology andMember, Medical Board, NIMHANSHon. Consulta.,t in Surgery andMember, Medical Board, NIMHANSHon. Consultant in Paediatric SurgeryHon. Consultant in PaediatricsHon. Consultant in E.N.T.Hon. Consultant in Thoracic SurgeryHon. Consultant in Orthopaedics Surgery

Asst. Director (Ayurveda)Resee -h Officer (Ayurveda)Asst. h. arch Officer(Clinical Psychology)

76 98

Statewise Distribution of Trainees

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cli o 5 a 6 Z3.,clo zj3 i'v) 1

MD. Degree in .

Psychological Medicine 9 -- 2 12 23 10 1 1 2 1 1 2 64D.M. DegreeIn Neurology 1 2 7 1 2 1 1 15M.Ch. Degree inNeurosurgery 5 1 4 2 1 1 2 16Diploma inPsychological Madicine 24 1 1 21 47 16 7 2 2 1 1 5 3 . 3 1 3 138PhD. in ClinicalPschology/M.H. & N.S. 3 3 1 1 4 1 1 14

. M. Phil in Medical &.

Social Psychology 6 1 5 20 31 17 2 5 2 5 1 3 7 1 2 108M. Phil inPsychiatric Social Work 7 9 27 20 2 2 1 68MPhil inNeuroPhysiology 2, 1 3Diploma inPsychiatric Nursing 8 2 3 7 2 2 25 104 4 9 3 3 8 11 2 2 4 199Diploma inNeuro Nursing 2 2

Total 59 2 4 8 11 2 95 248 70 24 11 9 16 21 10 15 6 4 3 5 4 627

.

99. .

MEMORIAL PRIZES AWARDED

D. L N. Murthy Rao Prize

Name of th? Student

1. Dr. Mohan K. Isaac2. Dr. C.- R. Chandrashekar3. Dr. R. Raghuram4. Dr. Shoba Annaiah5. Dr. K. Chandrashekar6. Dr. P. S. V. N. Sharma7. Dr. Uthpal Gowswami8. Dr. Shekar Pennathur Sheshadri9. Dr. Sumanth Khanna

State

KarnatakaKarnatakaTamil NaduKarnatakaAndhra PradeshAndhra PradeshWest BengalTamil NaduNew Delhi

Year

197519761977197919801981198219831984

M. V. Govindaswamy & D. L. N. Murthy Rao Memorial PrizebPN

Name of the Student

1. Sri P. K. G. Nambiat2. Smt. S. Janaki Shyamala3. Sri Nagarajaiah4. Miss T. P. Prema5. Capt. Miss. Harjeet6. Mr. Rachel Irwin7. Mr. E. Umapathiah8. Mr. Ramachandra9. Sister Juliana

State

KarnatakaKarnatakaKarnatakaAndhra PradeshPunjabKarnatakaKarnatakaKarnatakaKerala

Year

197519761978197919801981198219831984

M. V. Govinda Swamy Memorial PrizeDM &SP and MPHIL IN M &SP

Name of the Student State Year Course

1. Ms. Farida Abdulla Jammu & Kashmir 1975 DM&SP2. Smt. N. Sumathi Karnataka 1976 DM&SP3. Smt. Shakila Rani Shetty Karnataka 1977 DM & SP4. Ms. Shobana Sonpar Andhra Pradesh 1979 MM &SP5. Ms. K. Shailaja Kumari Andhra Pradesh 1980 MM &SP6. Ms. D. Sujatha Tamil Nadu 1981 M.Phil in M & SP7. Ms. Nomita Verma Tamil Nadu 1982 M.Phil in M & SP8. Mr. Craig Joseph Gonsalvez Tamil Nadu 1983 M.Phil in M & SP9. Ms. Elizabeth Daniel Karnataka 1984 M.Phil in M &SP

78100

SILVER JUBILEE AWARDS

M. V. Govinda Swamy Memorial Prize


1. Ms. Shaila V. Pai Karnataka 1975 D.P.S.W.2. Mr. Gomez Keith Conrad Linus Tamil Nadu 1976 D.RS.W.3. Mr. R. Parthasarathi Tamil Nadu 1977 D.P.S.W.4. Ms. Antony Lilly Pushpam Tamil Nadu 1979 M.P.S.VV.5. Ms. Leontine M. P. Rasquinha Karnataka 1980 MPhil in PSW6. Mr. T.S. Chandrashekara Karnataka 1981 M.Phil in PSW7. Ms. Vimala Uttarkar

Viswanatha Rao Karnataka 1982 M.Phil in PSW8. Smt. R. Sandhya Karnataka 1983 M.Phil in PSW9. Ms. Martins Joaozinha D. A.

Sagrada Familia Antonio Goa 1984 M.Pnil in PSW


1. Dr. Somnath Chatterji Bihar 1982 M.D. Psychiatry2. Dr. K. Srinivasan New Delhi 1983 M.D. Psychiatry3. E Avadesh Kumar Sharma Uttar Pradesh 1984 M.D. Psychiatry4. Dr. R. Pratap Chand Kerala 1982 D.M. Neurology5. Dr. Arun Kumar B. Taly Rajasthan 1983 D.M. Neurology6. Dr. Maya Gantayat Orissa 1984 D.M. Neurology7. Dr. K. S. Narayana Swamy Karnataka 1982 M.Ch. Neurosurgery8. Dr. B. A. Chandramouli Karnataka 1983 M.Ch. Neurosurgery

;E'' 379 121

World Health Organisation (WHO)Fellows trained at NIMHANS

1. Afghanisthan 32. Bangladesh 183. Burma 1

4. Deinocratic Yemen 35. Indonesia 126. Nepal 37. Somalia 48. Srilanka 89. Other (WHO Consultant) 1

Seminars/Symposia/ConferencernefresherCourses held at NIMHANS

1975National seminar on epilepsy.

1977Third conference of Indian Society of Psy-chlatric Social Work.First refer Sher course in behaviour therapyand biofeedback.National symposium on biological mem-branes and model systems.

1978National seminar on psychotherapeutic pro-cesses.

1979Joint conference of national organisationsof psychiatry, neurology, clinical psychologyand psychiatric social work.29th annual conference of the NeurologicalSociety of India.

National workshop on postgraduate train-ing in psychiatry.

National workshop on curriculum develop-merit in psychiatric social work.WHO workshop on postgraduate training inpsychology.

National seminar on neuro-oncology.

1980National workshop on recent advances inleprosy research.National seminar on health science libraries.

1981International workshop on new techniquesin neurosciences with special references tothe neurophysiology of higher nervousactivity.

National workshop on rehabilitation of men-tally disabled.

Seminar on inborn errors of metabolism inchildren in India and problem of mentalretardation.

1982Seminar on neurovirology.Symposium on yoga, brain and conscious-ness.National' seminar on paediatric neurosur-gery.

Workshop on mental hospital administra-tion.Symposium on how to add life to years.Second refresher course in behaviour thera-py and biofeed back.Third refresher course in behaviour therapyand biofeedback.

1983

First national seminar on neuroanaesthesia.Symposium on recent advances in under-standing the synaptic organisation and con-trol mechanisms of motor-sensoN system.Symposium on mind, brain and conscious-ness.

National workshop on techniques and applica-tions of computer analysis of the human EEGand brain stem far-field evoked potential.

First national workshop on family therapy.

Excerpta medica user education seminar.Fourth refresher course in behaviour thera-py and biofeedback.Symposium cum workshop on central auditory disorder.NIMHANS ADAMHA symposium.

1984

International symposium on motor neuronedisease.

81 1n3

Workshop in metrizamide myelogram.Workshop on experimental researchapproaches to study basic neurophysiologi-cal mechanisms of brain and behaviour.International symposium on biological psy-,chiatry with ADAMHA group.WHO workshop for parents and teachers onself help groups.Fifth refresher course in behaviour therapyand biofeedback.

A refresher course in recent advances inpsychiatry for psychiatrists.

Annual conference of Indian Society of Cri-minology.

Symposium on current research trends andprogress in understanding the physiology ofbrain and behaviour.

WHO workshop on national mental healthprogramme.

t

821 0 4

Publications of the Staff (Selected list)

PSYCHIATRY

1 Pradhan N , Channabasavanna S.M., Dwarakanath BS. & Talekar SV., Fick's Diffusion Model of Kinetics ofLithium, IRCS Med. Sc., 5, 273 (1977).

2 Pandurangi, AR , Ananth J & Channabasavanna S.M., Dyskinesia in an Indian Mental Hospital. Indian Jour-nal of Psychiatry 20, 339.342 (1978).

3 Naraya ian HS,, A Report of a Caste of Hallermann Streiff Syndrome, The Australian Journal of MentalRe-tardation (1978).

4 Gopinath PS & Kaliaperumal V.G , Comparative Study of Different Assessment Methods for Post GraduateTraining in Psychiatry. A Preliminary Study, Indian Journal Psychiatry 21, 153-145 (1979).

5 Kapur, RI. & Pandurangi A nand, K., A Comparative Study of Reactive Psychosis without Precipitant Stress,Brit. J. Psychiat., 135, 544.550 (1979).

6 Channabasavanna S.M & Bhatti R.S. 1. Rsychiatric Family Ward Treatment. An Appraisal. II. PsychiatricFamily Ward Treatment. How to choose a relative 'or) stay with the Patient Family Process (1980).

7 Chandrashekar, CR , Shamsundar, C., Kapur, R.L. & Kaliaperumal, V.G. Mental rr..nbidity among graduateand research students. An epidemiological study. Indian Journal of Psychiatry, 22, 89-93 (1980).

8 Pandey, R.S , Srinivas, KN & Muralidhar Sociocultural beliefs and treatment acceptance. Indian Journal ofPsychiatry, 22, 161.166 (1980).

9 Shivaprakash, Trivedi, S , Sashindran, C.H, Gandhi, I.S. & Adithan. Effect pretreatment with Phi wendazoleon the pattern of clinically induced convulsants therapies in patients. Indian Journal of Pht.rmaco-logy, 12 (I-11) 137.

10 Channabasavanna, S.M Group interactionas a method of family therapy. International J. Group Psychother,32( : (1982).

11 Pandey, Ravi S , Subramanya, Srinivas, K.N , Channabasavanna, S.M., Sridhara Rama Rao B.S. & Subbak-rishna, DR Serum lithium levels with slow release and conventional lithium. Indian Journal of Psychiatry,23(2): 169.173 (1981).

12 Pradhan, N., Umadevi, K , Channabasavanna, S.M., Subash, M.N. & Sridhara Rama Rao, B.S. A bi-compart-mental model system for lithium kinetics in mania. Indian Joumat of Psychiatry, 24(1) 31-36 (1982).

13 Kapur, R L , Chandrasekhar, C.R , Mohan K. Isaac, Parthasarathy & Shalini Shetty. Extension of mentalhealth services through psychiatric camps -A new approach. Indian Journal of Psychiatry, 24(3).237-241(1982).

14 Mohan K Isaac, Kapur, R L , Chandrasekhar, C.R., Kapur, M. & Parthasarathy, R. Mental health deliverythrough rural pm., ry care Development and evaluation of a training programme. Indian Journal of Psychia-try, 24(2) : 131.138 (1982).

15 Ray, R., Gopinath, PS. & Beig, MA. Customer approach and Waik in Clinic. International J. Soc. Psychiat,29(2): 118-126 (1983).

16 Ray, R , Beig, MA & Gopinath, P.S. Walk in Clinic drop outs. International J. Soc. Psychiat, 28(3). 179-184(1982).

17 Srinivas, K ,N , Murali, T, Shivakumar,P.S., Pandey, R.S. & Arya, BYE A case of pyknodysostosis with psycho.sis, Indian Journal of Psychiatry, 24(2): 190-191 (1982).

1,0 83

105

18. Srinivasa Murthy, R, Community Psychiatry in India The road ahead. In . Ramachandran, V., Pulaniappan,V & Shah, L.P. (Eds) Continuing Medical Education. Vol. 1 Indian Psychiatric Society, Bombay, (1983).

19 Narayanan, HS., Subash, MN. & Sridhara Rama Rao, B.S. A report of ten cases of Marinesco Siogrensyndrome detected at Bangalore, Austr. New Zealand J. Developmental disabilities 9(3) . 145147 (1983).

20 Narayanan, H.S. & Sridhara Rama Rao, B.S. Genetic and clinical findings in fifty two cases of Bardet Biedlsyndrome in 23 families. Austr. New Zealand J. Developmental disabilities 9(3). 145-147 (1983).

21 Channabasavanna, S.M. et al. Transition from simple writer's cramp to dystorlic writer's camp - Clinical Neu-rology and Neurosurgery, 85:(2) (1983).

22 Gangadhar, B.N., Roy Cowdhary, J. & Channabasavanna, S.M. E.C.T. and drug induced parkinsonisin.IndianJournal of Psychiatry, 25(3): 212-213 (1983).

23. Srinivasa Murthy, R. Mental Health Care Manuals -A Review NIMHANS JOURNAL 1 (Z . 91 98 (1983).

24 Desai, N., Gangadhar, BN., Pradhan, N. & Channabasavanna, S.M. Extro amphetamine in negative schizophrenia. Am. J. Psychiatry, 141: 723.724 (1984).

25 Chaturvedi, SIC., Gopinath, PS. John Mathew, P. & Albert Micheal. Negative symptoms and negative schizophrenia. Indian Journal of Psychiatry 26(3): 200.295 (1984).

26 Chaturvedi, SIC., Michael, Ajohn Mathew, P. & Gopinath, P.S. Negative symptoms in chronic schizophrenia-A clinical study. NIMHANS JOURNAL 3(1): 17.20 (1985).

27 Desai, Patti, Gangadhar, BN & Channabasavanna, S.M Catatonia associated with manic encephalopathy.Clinical Neurology and Neurosurgery, 86(2): 107.110 (1984).

28. Gangadhar, BN. Side effects of somatic therapies in depression - A double blind l.umpansun uf ECT &pramine. NIMHANS Journal 3 (1): 13.16 (1985).

29 Gangadhar, BN., Kapur, R.L & Kalyanasundaram, S. Effect of ECT in endogenous depression -A doubleblind comparison with imipramine. NIMHANS JOURNAL 3(1). 712 (1985).

30 Shivaprakash, S. Aggressive behaviour disorders in children. Indian J. Paediat (1984)

31 Janakiramalah, N Somatic Neurosis in Middle Aged Hindu Women. International Joumul of sr,ocial rsychi9try, 29(2): 113.116 (1983),

32 Shivaprakash, V. Patterns of Child and Adolescent Psychiatric disorders in India tBased ori Collaborative study 1981 83) In . Continuing Medical Education Pr ugramme, Indian Psychiatric Society, (Ed) Rama-chandran et al. 17.23 (1984).

33 Multi axial classification in child psychiatry Dr. Shivaprakash In Continuing Medical Education Programme, Indian Psychiatric Society, Vol V, 1985, (Ed) Prof. Abraham Verghese.

CLINICAL PSYCHOLOGY

1 Balodhi, JP Phenomenology of aggression in ancient Indian thought . An Analysis uf Rigveda. Vedic Path46 : 14.20 (1984).

2 Balodhi, J P & Mishra, H Patantali yoga and behavioui therapy. The Behaviour Therapist b. 1% 197(1983).

3 Kodanda Ram. P. & Murthy, V.N. Drug abuse among Juvenile delinquents. In. Mohan, D Sethi. H S. &Tongue. E. (Eds) Current Reserch in Drug Abuse in India, New Delhi, AIIMS (1981).

4 Kodanda Ram, P. & Rao, VN Emotional problems of institutionalised children In. Dube. S. & Sachdev, PS,(Eds) Mental Health Problems of the Socially Disadvantaged New Delhi, Tata McGraw Hill 11983)

5 K umaraiah, V Behavioural treatment of drug addiction. A multiple approach Indian J, Clin rso,hoL 6.4346 (1979).

6 Kumaraiah, V EMG biofeedback and progressive muscular elaxation in treatment of tension headache Indian J. Clin. Psychol. 7: 1.5 (1980).

84

1 0 6

7. Malavika Kapur, & Illana Cariappa.Traming in counselling for school teachers. International Journal forthe Advancement Of 'Counselling 2: 109.115 (1979).

8. Malavika Kapur & Kapur, R.L. An approach to identify potential mental health counsellors arr..mgst schoolteachers. NIMHANS JOURNAL 1: 151.155 (1983).

9. Malavika Kapur, Murthy, V.N., Sathyavathi, K. & Kapur, R.L. (Eds) 1'roc -dings of the National Seminar onPsychotherapeutic Processes. Bangalore, NIMHANS (1979).

10. Prabhu, G.G. Mental Illness. Public attitudes & public education, Indian J. Ciln Psycho! 10 1 16 (1983)

11. Prabhu, G.G., Ahalya Raghuram, Nomita Verma. & Annette C. Manadass Public attitudes toward Mental illness: A review. NIMHANS JOURNAL 2: 1.14 (1984).

12. Pasricha, S. & Stevenson, I, Three cases of the reincarnation type in India. Indian J. Psychiat 19. 36 42(1977).

13. Pasricha, S. & Stevenson I. Near death experiences m India A preliminary report Journal of Nervous andMental Disease (in press).

14. Sathyavathi, K. Short form of Maslow's security 1-1security inventory further validation Indian J. Clin Psychol. 7: 139.142 (1980).

15. Sathyavathi, K. & Thomas, A. An attributional approach to locus of control, Self esteem and alienation Aclinical study, Psychological studies, 29: 76.82 (1.984).

PSYCHIATRIC SOCIAL WORK

1. Bhatti, R.S. & Channabasavanna, S.M. Social system approach to understand marital disharmony Ind JSoc. Mirk 40 (1979).

2. Bhatti, R.S., Janakiramaiah, N., Channabasavanna, S.M. & Shoba Dew. Description and quantification ofmultiple family group interaction. Indian. J. Psy. 22(1): 51.55 (1980j.

3. Bhatti, R.S., Janaltiramaiah, N. & Channabasavanna, S.M. Group interaction as a method of family therapyInt. J. Group Psychother. 32: 103.114 (1982).

4. Bhatti, RS. Family therapy in alchohsm. In . The Christian responsv alcohol & drup problem Eds. J.K Lawton, Gnanadason & K.Y. Mathew, Pub. ECC, Bangalore & 'PADA. London 72 99 (1983)

5. Chamundi Eswan, S., Shariff, I.A. & Sekar, K. Hysterical personality traits among feinalc offenders Indian JCriminol. 10(2): 124-128 (1982).

6. Chamundi Eswan, S., Shariff, IA., Sekar, K., Murandhar, D., G owthaman, S & Btdaiakoppa. CS An inventory to measure the up bringing of children Its efficacy in the Indian setting Child Psy (12(1) 69 (1984)

7. Marulasiddalah, H.M. & Shariff, IA. Medical and psychiatnc social work education and social work practicein India Nair, T.K.. ASSW Publications, 172.184 (1981).

8. Muralidhar, D., Sekar, K., Chamundi [swan, S. & Shariff, IA. P. ycho social correlates of instutiorialisation inchildren. J. Rehab. Asia 24(3): 10.17 (1983)

9 Nardev, G. & Sathyavathi, K. Length of stay of discharged mental patients in the corrimunity in relation totheir posthospital adjustment. J. Rehab. Asia 19(1): 26.34 (1978).

10. Pal, S. & Kapui, R.L. Burden on the fan-lily of the psychiatric patient . Development of an interview scheduleBrit. J. Psychiat. 138: 332.335 (1981).

:1. Pal, S. & Kapur, R.L. Evaluation of Home care treatment for schico,,:.i.nic patients Acta Psychiatrica Scandinauica 67: 80.88 (1983).

12. Rao, V.N., Channabasavanna, S.M. & Parthasarathy, R. Anxiety provoking situations in Indian families Int. JSoc. Psy. 30(3) : 218.221 (1984).

13. Sekar, K., Chamundi Eswan, S., Indiramma, V, Shariff, IA. & Murthy, N.SN The use of Rutter's Scale byteachers in screening maladjusted behaviour among children. NIMHANS JOURNAL 1(2) 105 110 0983)

85 .107

14 Senthilnathan, S .M Sekar, K., Radha, U & Shariff, IA. Soda. .djustment of industrial alcoholics. Ind. J. Crim.12(11): 3.7 (1984).

15 Shariff, IA, Uday Kumar, GS & Mohan, A Social work In clinical setting. Base of its practice at NIMHANS.J. Rehab. A ski 31(3): 5.10 (1982).

16. Shariff, IA. Socitherapy with neurotics. Ind J. Soc. Research 23(3) . :15-119 (1982).

17 Shariff, IA & Sekar, K Social predictors In juvenile delinquency. Ind J. Crim, 10(2). clf. 46:1982).18 Shariff, IA Social work intervention in anxiety neurosis. Int. Soc. work, 140 : 3.37 (1983).

NEUROLOGY

1 GeurteDevi, M , Padmini, R & Satish, P Use of Intrathecal hyaluronidase in spinal arachnotditis Inuian J.Med Res. 71, 581.593 (1980).

2 Gourie-Devi,M & Satish, P Hyaluronidase as an adjuvant in the treatment of cranial arachnotditis (Hydroce-phalus and Optochiasmatic arachnotditis) complicating tuberculous meningitis. Acta Neural. Scant:. 62, 368381 (1980).

3 Gourie-Devi, M & Taliath, H Conduction study of dorsal cutaneous branch of ulnar nerve in normal humansubjects and in leprosy, Electro. Enceph. Clin. Neurophysiot 52, (3) SI S165 (1981).

4 Gourie-Devi, M & r)eshpande, D.H. Japnese Encephalitis, In. Paediatric Problems. F rasad, L.D., & Kulc-zycki, LL (Eds). S. Chand and Company Ltd., New Delhi, pp 340.356, (1982).

5 Gouric Devi, M & Nagaraja. D Multiple Sclerosis in South India. In.Multiple Sclerosis East and West, Kum-wia, Y. & Kurland, L.T. (Eds). S. Karger, Basel, Switzerland, pp. 135.147 1982.

6 Gourieevi, M , Suresh. TG and Shankar, S.K. Monomelic A myotrophy. Arch. Neural. 41, 388.394 (1984).7 Gourie-Devi, M & Satish, P ILtrathecal HyaluronidaseTreatment of Chronic Spinal Arachnoiditis of Norm-

fective Etiology. Stag. Neural. 22, 231.234 (1994).

8 Gourie-Devi, M Greater auricular nerve conduction in Leprosy. Indian J. & Leprosy, 55, 182.190 (1984).9 Gourie-Devi, M & GanapathY. GR Phrenic nerve conduction time in Guillain-Barre syndrome. J. Neurol.

Neurosurg. Psychlat 48, 245-249 (1985).

10 Gourie-Devi, M , Rao, VN & Rajaram, P Neuroepidemoilogical study in semiurban and rural areas in SouthIndia Pattern of Neurological disorders including motor neurone disease. In . Motor Neurone Disease. Glo-bal Clinical Patterns and International Research. M. Gourie-Devi, (Ed) Oxford & IBM (in press).

11 Gourte-Devi,M Acute symmetical motor neuropathy in Diabetes Mellitus. A distinct clinical entity. DiabetesBull. 5, 47.59 (1985).

12 Mani, K S Mani, A.: Ramesh, CR Ahtija, G.K, Sphenoidal Electroe:-mvplialography with MethohexitoneActivation. A Study in 108 patients, Neurol. India, 20, Supp. 2, 252.256 (1972).

13 Mani, KS . Mani, AJ . Ramesh, CR & A h a, G.K Hot Water Epilepsy-Clinical and Electrophysiological Fea-tin es Proc. X int. Cong. Neurol. Exc. Medlca, Int. Cong. Series, 1973, pp. 81-86.

14 Mani, KS Neurological Disease In South India In . Tropical Neurology, ID. Spillane, (Ed.) 1973. pp 78.85,Oxford University Press, London.

15 Nagaraja, D & Pratapchand, R. Prognostic factors in Stroke, NIMHANS JOURNA ' 1, 141.144 (1983).16 Nagar*, D. Srinivasa, R , Subhash, MN & Rao. B.SS. Homovanilic acid and 5 hydroxy indole acetic acid in

the CSF in Rheumatic chorea. Indian J. Med. Res. 78, 94.99 (1983).

17 Pratapchand, R & Gourie Devi, M The Blink reflex and somatonsensory evoked potential in optic neuritis inSouth India. Acta. Neurol. Scand 71, i50.155 (1985).

18 Swamy, il S , Shankar. SK , Satish, P, Arc.por, SR. Shivaramakrishna, A, & Kahaperumal, V.G. Neurologicalcomplications due to Beta - Proplolactone (BPL) inactivated Antirabies Vaccination. J. Neurol. So. 63, 111128 (1984).

19 Shankar, SK , Re njen, RN , G o urie Devi, M & Deshpande, D11 Vascular TY....iopac;hes A Pathological Stu-dy of 14' cases. Neurol. India 31, 41.50 (1983).

I ,86, 108

NEUROSURGERY

1. Vidyasagar, C. Persistent embryonic veins in the arteriovenous malformations of the dura Acta NeurochirFase 34, 199-216 (1979).

2. Vidyasagar, C. Persistent embryonic veins in arteriovenous malformations of the brain Acta Neurochir 40103.166, (1978).

3. Vidyasagar, C. Persistent embryonic veins in arteriovenous malformations of the posterior fossa Acta Neuro-chit.. 48: Fase 1.2, 61.82 (1979).

4. Deshpandc, D.H. & Vidyasagar, C. Histology of the persistent embryonic veins in arteriovenous malformations of brain. Acta NeurOchir. 53: Fase 3.4, 227 -236 (1980).

5. Vidyasagar, C. Persistent embryonic veins in arterovencus malformations of the brain Acta Neurochir 40117 (1978).

6. Vasudeva Rao, T., Narayana Swamy, KS., Shankar, S.K. & Deshpande, D.H. Primary spinal epidural lympho-mas -A clinicopathological study. Acta Neurochir. 62: Fase 3.4, 307.317 (1982).

7. Torvik, A., Bhatia, R., & Murthy, V.S. Transistory block of arachnoid granulations following subarchnoid haemorrhage. Acta Neurochir. 41: Fase 1.3, 137-146 (1978).

8. Torvik, A. & Murthy, V.S. The spinal cord central canal in Kaolin-induced hydrocephalus J Neurosurg, 47397 (1977).

9. Murthy, V.S. & Deshpande, D.H. The central canal of the filum terminals in communicating hydrocephalusJ. Neurosurg. 53(4): 528.532 (1980).

10. Chandramukhi, A., Narayana Reddy, GN. .& Hegde, A.S. Anaerobes and brain Indian J Surg 43(1) 90-96(1981).

11. Chandramukhi, A., Hegde, AS. & Narayana Reddy, G.N. Anaerobic brain abscess Role of metronidazole inchemotherapy. NeuroL India 37(4) 213.218 (1980).

12. Shankar, S.K., Hegde, A.S., Vasudev Rao, T. & Sarala Das. Optic neuritis and atrophy -A pathological appraisal CME, Madurai 1983, Neurological Society of India %Ed.) S. Kalyanaraman.

13. Narayana Reddy, GN., Srivastava, V.K. & Deshpande D.H. Infratentorial midline cystic arachnoiditis -Anenigma. NeuroL India 20(1) . (1982). Venttriculographic patterns in posterior fossa cystic arachnoiditis Neu-roL India 30(3): 139.149 (1982).

14. Narayana Reddy G.N. & Prusty G.K. Unusual presentation of tuberculomata Indian J Tuberculosis 30 97100 (1983).

15. Narayana Swamy, KS., Reddy, AR., Srivastava, V.K , Das, B.S. & Narayana Reddy, GN Intraspinal arachnoid cysts. Clin. NeuroL Neurosurg. 86(3) :16.

16. Narayana Reddy, G.N., Srinivas, KN. Mallikarjunalah, M. & Venkataswamy Reddy Experiences of neuropsychiatric clinic at Gunjur. Indian J. Psycho!. Med. 3(2): 81-84 (1980).

17. Rao, B.S.S., Narayanan, H.S. & Narayana Reddy G.N. N acetyl neuraminic acid levels in CSF of patients withpsychiatric and neurological disorders. Indiah J. Exp. Psycho!. 17: 118 (1975).

18. Extracranial to intracranial anastomosis and repair. In. CNS Plasticity & Repairs Haven Press, Net York,(1985).

19. Narayana Reddy, G.N. Innovations in neuropsychiatric services. NIMHANS JOURN, IL 1(1) 1 14 (1983)

NEUROANAESTHESIA

1. Sane, H. Terminology of ventilon. Asian Arch. Anaesthesia (1982).

2. Narayana Reddy, G.N. & Parameswara, G. Proceedings of National Seminar on Neuroanaesthesia, NIMHANS publication (1984).

,.-

SPEECH, HEARING & LANGUAGE

1 Nagaraja, MN Development of synthetic speech identification test in Kannada language, J. AlISH 8. (1980).2 A huja, G I{ , Verma, A , G hosh, P & Nagaraja, MN Stapedius reflexometry-diagnostic test of My asthenia gra-

vis. J. Neurol. ScL 46: 311.314 (1980).

3 Nagaraja, MN & Shivashankar, N General principles of speech and language therapy with congenital deafchildren. J. Rehabilitation in Asia (1981).

4 Nagaraja, MN , Shivashankar, M_ & Narayanan, H.S. Efficacy of ;peach and language therapy in severe men-tally retarded children. J. Psycho) Med. (1981).

5. Shamala Chengappa. Code alterations in bilinguals. Psycholingua (1984).

6 Nagaraja, MN & Shivashankar, N Abnormal acoustic stapedial reflex pattern in a psychiatric patient. IndianJ. Otolaryngol. 36(3) : 95-97 (1984).

NURSING

1 Pillai A S , Nagalakshmi. SV 'Nurse-Patient relationship therapy in socialising chronic schizophernic pa-tients. The Nursing Journal of India. Vol. LXVI, Na. 3, 53-54 (1975).

2 Ms Shaila Pai Mr Nagarajaiah, 'Treatment o. Schzophe...ic patients in their homes through a visiting nurse-some issues in Nurses Training' International Journal of Nursing studies, Vol. 19, No. 3, 167-172 (1982).

3 Reddemma, K 'Psychiatric Nursing' The Nursing Journal of India, Vol. LXXIII, No.5, 144-146 (1982)..4 Lalitha, K 'Focus on NIMHANS - Helping the handicapped', The Nursing Journal of India, Vol. XXIV, No. 4,

90-92 (1983).

5 Aleyamma Abraham, Book review on 'Essentials of Psychiatric Nursing. by Cecelia Mount Taylor, (The C.V.Mosby Co., St Louis, Toronto, London), 1982, Pages 699 + XVI, NIMHANS JOURNAL, 1, (2) (1983).157-158.

6 Lalitha K Book review on Psychiatric Nursing careplans. by Judith M Schultz and Sheila L. Dark, (LittleBrown & Co Boston, INC, USA.) 1982 1st edition. Pages 173, NIMHANS JOURNAL, 1, (2) 158 (1983).

7 Nagarajaiah, 'Role of Nurses in thental health research' NIMHANS JOURNAL, 2, (1) 41.45 (1984).

8 Lalitha, K Nagarajaiah, 'Mental Health Nursing in Piimary Health Care, The Nursing Journal of India', Vol.LXXV, No. 9, 209.213 (1984).

9 Shaila Pai & Nagarajaiah 'Community Care of Psychiattic Patients in India International Nursing Review.Vol. 31, No. 5 (ICN) (1984).

NEUROCHEMISTRY

1. Subhash, MN Channabasavanna, S M. & Rao, B.S.S. Erythrocyte lithium assay. J. Med. So. 1(1) 17-18(1983).

2 Bhagawat, V.R , Subhash, M N , Jayasimha, N & Rao, B.S.S Biochemical monitoring of antiepileptic drugsNIMHANS JOURNAL 1(1) 15-18 (1983).

3. Rao B S S, Subhash, M.N & Narayanan, H.S Inborn errors of metabolism associated with mentalretardation In 'Frontiers of Knowledge in Mental Retardation' (Ed) Mittler, York press, Baltimore Vol -1l(1981).

4 Subhash M N, Shankar, S K & Rao, B S.S Tissue LDH isozymes in brain tumors. Curr. Sci., 50(19) 868(1981).

5 Sampath G, Channabasavanna, S.M., Rao B.S S. & Subhash MN Body weight dosage relationship of lithiumcarbonate in manics Indian J. Med. Res. 74, 750 (1981).

6 Rao B S S, Subhash MN & Reddy, G.N.N Enzyme assay & protein fractionation in CSF and serum of I 1-tients with brain tumors., Proc Natl. Seminar on Neurooncology, 111 (1979).

,x A " 1_1

7 Subhash, MN., Ndrayanan, H.S. & Rao, B.S.S. Phenyalanine tolerance test in parents of PKU. A cta A ntrop-gen., 1, 37 (1980).

8 Rao, B.S.S., Subhash, MN. & Narayanan HS. Studies on the excretion of DMPEA schizophrenics. Indian J.Psych. 18, 53.58 (1976).

PSYCHOPHARMACOLOGY

1 Pradhan. N & Channabasavanna SM. "Relationship between plasma and erythrocyte sodium potassiumand lithium in lithiumprophylaxis". Ind J. Psychiet. 25(1), 34-39 (1983).

2 Desai, N., Gangadhar, BN., Pradhan, N. & Channabasavanna, S.M. Amphetamine in negative symptoms ofschizophrenia. Am. J. Psychiat. 141, 723-724 (1984).

3 Mayanil, C.S.K. & Baquer, N.Z. Kinetics of the mechanism of action of Monoamine Oxidase in the regulationof Nab- K+ ATPase activity in rat brain. J. Neurochem. 44(1), 25-30.

NEUROPHYSIOLOGY

1 Desiraju, T Reorganisation of neuronal discharges i.i cerebral cortex through changing states of conscious-ness In Mechanisms in transmission of signals for conscious behau our. Edited by T Desiraju, Elsevier Press.

Amsterdam, Oxford & New York, 1976, 253.283.

2 Desiraju, T (Ed.) Mechanisms in Transmission of Signals for Conscious Behaviour. Elsevier Division of theAssociated Press of Elsevier, North Holland and Excerpta Medical Publishers. Amsterdam, Oxford & WA,York. (with 16 chapter-reviews by Purpura, DP., Bennett. MVL., Albefessard, D., Asratyan, EA.,Gilman, S , Ito, M., Bechtereva, NP., Desiraju, T, Steriade, M., Horn. G., Chase, M.H., Pribram, K.H., Oomura,Y., Kubota, K., Besson, JM., Guilbaud, G., Phillips, C.C., Highstein, S., and Buchwald, NA.,) (1976).

3 Desiraju, T Electrophysiology of the frontal granular cortex. III. The cingulate prefrontal relation in prim-ate. Brain Research, 109: 473485 (1976).

4 Desiraju, T. Mechanisms of cerebral functions and principles of or ation of primate brain. In. Use of non-human primates in biomedical research. Prasad, M.R N. and Anand ..,,mar T.C. (Eds.). Indian National Sci-ence Academy, 288-309 (1977).

5 Desiraju, T Recent insights into understanding the probletii of pattern generation and pattern recognitioninthe communication of coded information across nerve cells of brain. In. Recent developments in pattern re-cognition and digital techniques. Edited by . D. Dutta Majumdar, 269-287. Indian Statistical Institute, Cal-cutta (1977).

6 Desiraju, T Electrophysiology of prefrontal dorsolateral cortex and limbic cortex elucidating the basis andnature of higher nervous associations in primate. In. Brain Mechanisms in Memory and Learning. Edited byMary AB. Brazier, 79-89. Raven Press, New York, 1979. Proceedings of IBRO Symposium held at the RoyalSociety, London, July 1977.

7 Desiraju, T Neurosciences World Wide. Current Status and Prospects in India. Trends in Neurosciences(TINS), Elsevier Press, Amsterdam, August 1978, VVI.

8 Desiraju, T Introduction to functions of mammalian associative cortex. Clues to functionalorganisation of af-ferenting projections in dorsolateral prefrontal cortex. In . Advances in Physiological Sciences, Vol. 17 Brainand Behaviour Eds. Adam, G., Meszaros, I. and Banyai, E.I., 267 276. Akademia Kaido, Budapest, and Perga-mon Press, Oxford, (1981).

9 Desiraju, T Concluding remarks on functions of mammalian associative cortex. (Chairman's note on the sym-posium) In. Advances in Physiological Sciences, Vol. 17, Brain & Behaviour. Eds. Adam, G., Meszaros, I.,Banyai, E.I., 319-322. Akademia Kiado, Budapest, and Pergamon Press, Oxford, (1981).

10 Desiraju, T Physiology of sleep. In . Scientific Lectures of Continuing Medical Education Programme of 1981,Part I. Edited by Kalyanaraman, S., 163-173. Neurological Society of India Publication, (1981).

11 Kanchan, B R , Meera Rau & Desiraju, T A simple method for insulatin. g metal electrodes suitable fur implan-tation in the brain. Indian Journal of Physiology & Pharmacology, 26. 250-252 (1982).

12 Desiraju, T Issues of Interrelations of Brain and Consciousness. NIMHANS JOURNAL, 1(1). 69-70 (1983).

13. Destraju, T. & Narayan Rao, D. Neurophysiology of organisation of the reward system. Proceedings of International Union of Physiological Sciences, 29th Congress, Sydney, August 1983, Vol, 15 (1983).

14. Desiraj u, T., Rajanna, B. & Mascarenhas, C. Electroencephalographic power spectral abnormalities produk.edby imposing malnutritional states on developing rat. Biomedicine, 4. 27 35 (1984)

15. Mascarenhas, C., Rajanna, B., Muniyappa, K. & Desiraju, T. Efficiency of a commercial rat feed and threeother constituted diets in sustaining the body grdwth of rats. Indian Journal of Medical Research, 80. 218227 (1984).

16. Rajanna, B., Mascarenhas. C. & Desi.aju, T. Experimental study on rats to find the usefulness of nutntionalsupplementation to undernourished offspring of parents undernourished life lung. Indian Journal of Physiclogy & Pharmacology, 28: 83.96 (1984).

NEUROPATHOLOGY

1. Deshpande, D.H., Murthy, VS. & Narayana Reddy, G.N. Chronic subdural hematoma in the cerebellopontineangle. Surgical Neurology, 14(3) (1980).

2. Deshpande, D.H. & Vidyasagar, C. Hypertiophic pachymeningitis dorsalis Surgical Neurology, 12(3) 1979

3. Deshpande, D.N. Japanese Encephalitis in India Indian J. Pediat. 47.

4. Murthy, V.S. & Deshpande, D.H. The central canal of the filum terminale in communicating hydrocephalusJournal of Neurosurgery. 53(4) : (1980).

5. Sarala Das & Sathyavathi, B. Muscle biopsy as a diagnostic aid and its limitations Continuing Medical EducaLion Programme, NSI, Cuttack, (1982).

6. Shankar, S.K., Deshpande, Dli., Snnwas, HV. & Kalyanasundaram, S , Dementia -A pathological studs,Neurology India, 30: 93.103, (1982).

7. Shankar, S.K., Vasudev Rao, T. Vidyasagar, C. & Deshpande, D.H. Yolksac tumour of the pineal region IndPaediatrics, 18 : 581.584 (1981).

8. Shankar, S.K. Problems in histupathological diagnosis of brain tumJurs Proceedings of National Seminar onNeuro-oncology, NIMHANS Bangalore, (1981).

9. Shankar, S.K., Vasudev Rao, T., Gourie Dei 1, M & Deshpande, D.H. An autopsy study of brains during an epidemic of Japanese encephalitis in Karnataka, South India. Indian J. Med. Res. 431 440 (1983).

10. Shankar, S.K. Archnoidal villi in human optic nerve NIMHANS JOURNAL, 1.145 -150 (1983).

11. Vasudev Rao, T., Rajendran & Deshpande, D.H. Herpcs simplex encephalitis- A case report. NeurologyIndia: 27 :183-186 (1979).

12. Vasudev Rao, T., & Deshpande, D.H. Malignant subdural efflusion Acta Neurochurgica, 52 61 65, (1980).

13. Deshpande, D.H., Srinivas, H V., Vasudev Rao, T. Reyes Syndrome Report of 6 autopsied cases. Indian Paediatrics, 17 (17), 3.8 (1980).

14. Srinwas, HV., Vasudev Rao, T., Deshpande, D H. Cerebral cysticercosis. Clinical and pathologicalobservations with emphasis on the encephalitic. type. Clinical Neurology & Neurosurgery 82 3, 187 -197(1980).

15. Vasudev Rao, T., Ramamohan, Y., Shankar, S.K. & Deshpande, D H. A technique for semithin paraffin sections Ind. J. Path. Micro, 27 :169-71 (1984).

16. Vasudev Rao, T., Pun, R. & Reddy, G.N.N. Granular cell myoblastoma of the 5th Cram., nerve A case report. Journal of Neurosurgery- 59:706.709 (1983).

17. Vasudev Rao, T. & Sarala Das. Cerebral cysticercosis in children An emphasis un its association with Japanese Encephalitis and the encephalitic varient.

18. Shankar, S.K., Gourie-Devi, M., Nagaraj, D., Vasudev Rao, T. & Sarala Das. Neuromyelitis optica A report ofan autopsy proven case. Journal of Association of Physicians of India 32(4), 371 373 (1984).

1,

t v 390112

BIOPHYSICS

1. Talekar, Mikulecky, D.C. & Gary-Bobo. C.M. A new current expression for selective ion permeationacross membranes. J. theor..Biol. 87:663.669 (1980).

2. Talekar, SW., CSF cytology and microbiology using a new in-uiuo filter technique J Neurosci Methods 2107-108 (1980).

3. Otto, F.J., Oldiges H. & Jam, V.K. Flow cytometrtc measurement of cellular DNA content dispersion inducedby mutagemc treatment. In . Biological Dosimetry (Eds.) Eisert, W.G., & Mendelsohn, Mt , SpringerVerlag

(1984).

4. Jain, V.K., Oto,F.J. & Goptnath, P.M. Application of flow cytometry in genetic research Proc Int.Symp MedGenetics Madras. Pergamon Press (1983) (in press).

5. Dwaranakath, BS., Jain, V.K., Sarala Das & Das, B.S. DNA flow-cytometry of brain tumors A preliminarystudy. NIMHANS JOURNAL 2 : 141-148 (1984).

6. Bhaumik, K, Mukhopadhyay, R., Dwarakanath, B.S. & Jain, V.K. Optimization of cancer therapy Develop-

ment of a cell kinetic model for tumour radiotherapy. NIMHANS JOURNAL 2.129 -140 (1984)

7. Bhaumik, K., & Jain, V.K. Mathematical models for optimizing tumour radiotherapy I A pimple two com-ponent cell-kinetic model for the unperturbed growth of tramplantable tumours Cell Tissue Kinet. (submit-

ted).

8. Jain, V.K., K alia, V.K., Sharma, R., Maharajan, V. & Menon, M. Effects of 2-deoxy-D glucose on Glycolysis, Pro-liferation Kinetics an Radiation Response of Human Cancer Cells Int. J Radiation Oncology Biol Phys.11 : (1985) (in press).

9. Dwarakantith, B.S. & Jam, V.K. Enhancement of Radiation Damage by 2 deoxy D-glucose in Organ Culturesof Brain Tumours. Indian J. Med Res. (in press).

10. Jam, V.K., Pansari, A. & Dwarakanath, B.S. Energetics of DNA Repair A Study Using 31P NMR Spectro-scopy in Eukaryotic Cells. Abst. XI International Conference on Magnetic Resonance in Biological Systems,

Goa, 102 (1984).

CYTOGENETICS

1. Narayanan, H.S., Mohan, KS., Manjunatha, K.R. & Channabasavanna, S.M. An unusual variant of Hallermann-Streiff syndrome. Indian J. Psychiat. 27(2), 159-162 (1984).

2. Narayanan, H.S , Rao, B.S.S. & Manjunatha, K.R. Studies on the Cytogenetics and Dermatoglyphic patternsof Down's syndrome cases. NIMHANS JOURNAL (in press).

BIOSTATISTICS

1 Ahula, G.K., Karanth, P. & Kaliaperumal, VG. Factors related to improvement of aphasia in patients withstroke. J. Rehab. Asia 19:15.20 (1978).

2. Chandrashekar, C.R., Shrikhande, SA., Channabasavanna, S.M. & K aliaperumal, VG suic;dal ideation andits relevance in psychiatric practice. Indian Journal of Psychiatry, 21.345 -347 (1979)

3. Chandrashekar, C.R., Channabasavanna, S.M. & Venkataswamy Reddy, M Hysterical possesion syndrome,Indian Joc.mal Psy. Med. 3(1), 35.40 (1980).

4. Channabasavanna, S.M., Keshavan, M.S., Chandrashekar, C.R & Venkataswamy Reddy, M A retrospectivestudy of clinical and demographic factors in puerperal psychosis, Kerala J Psychiat, 5(11), 1 6 (1978)

5. Channabasavanna, S M., Sridhara Rama Rao, B.S., Sampath, G , Vikram Kumar, Y,Subbakrishna, D K Residential effect of lithium Indian J. Med. Res, 72:908 -909 (1980).

o. Channabasavanna, S.M., Subramanya, B., Gangadhar., John. C.J & VenkatasiNamy Reddy Mental healthdelivery system of India a brief report. Indian Journal of Psychiatry, 23(4), 309-312 (1981)

7. lanaitiramaiah, N., Badrinath, B., aannaba ,anna, S.M. & Kaliaperumal, VG Dealing wi.n deviant behaviour. Indian Journal of Psychiatry, 21 : 206-210 (1979).

A 91t13

8 Janakiramalah, N & Subbakrishna, D.K. Somatic illness among Muslin. vomen in India. Social Psychiatry15 : 203.206 (1980).

9 Janakiramaiah, N & Subbakrishna, D.K. ECT Chlorpromazine combination comparison with chlorpro-mazine only in schizophrenia. Indian Journal of Psychiatry, 23(3) : 230-33 (1981).

10 Janakiramaiah, N , Kapur, R L & Subbakrishna, D.K. A double blind comparison of single dose of impramineat bed time with T.D. dosage of impramine. Indian J. Psy. Med. 97-100 (1981).

11 Janakiramalah, N & Subbakrishna, D.K. Factor structure of neurotic illness. Indian J. Clinical Psychology10:55.60 (1983).

12 Mahal, A S , Janakiramaiah, N & KaLiperumal, V.G. A comparative trial of fluphenazine nortriptuline com-binations in depression. Indian Journal of Psychiatry 18 : 187-192 (1976).

13 Mani, K S , Mani, A .J Ramesh, C.K , Subbakrishna, D.K. & Kaliaperumal, V.G. Auras in temporal lobe epilep-sy and their clinical significance Proceedings of the N ational Semina r on Epilepsy, Bangalore 55.60 (1975).

14 Ray R , Sekar, K & Subbakrishna,!:.K. Reliability of information provided by the alcoholics. Indian J. Med.Res. 79 : 691-693 (1984).

AYURVEDIC RESEARCH

1 Mahal, A S , Ramu, M.G., Chaturvedi, D.D., Thomas, K.M., Hemalatha, Senapati, M. & Narasimha Murthy,N S Double Blind controlled a study of Brahmyad4 oga and Tagara in the management of various types ofUnmada (Schizophrenia), Indian J. Psychiat. 18:283 -292 (1976).

2 Mahal, A S , Chaturvedi, D.D., Ramu, M.G., Janakiramaiah, N. & Narasimha Murthy, N.S. A clinical study ofUnmada (Unmada lakshana samucchaya adhyayana) Indian J. Psychiat 19(3).19-26 (1977).

3 Ramu, M.G & Venkataram, B.S. Role of Ayurveda in total health care, Naganun, 23(4) .67-70 (1979).4 Ramu, M G , Shankara, M.R , Leelavathy, S. & Narasimha Murthy, N.S. Effect of Ayurvedic treatment in Un-

mada (182 cases), Sachitra Ayurveda. 32(6): 310-313 (1979).

5. Ramu, M.G. Ayurveda and Mental diseases, Swasth Hind, 24(4).337-339 (198,_

6 Ramu, M G , Chaturvedi, DD , Hemalatha, Senapati, M. &Narasimha Murthy, N.S. Controlled study on roleof Ksheerabala taila in Psychogenic headache (Vataja shira shoola), Journal of Research in Ayurveda andSiddha, 1(2) : 291-300 (1980).

7 Ramu, M G , & Venkatara.m, B S. Need for an organised Ayurvedic Library and miurroation system, In : lyen-gar, TK S , fswara Bhat, M. (Eds ) Proceedings of National Seminar on Health Science Libraries in India,NIMHANS, Bangalore, (31-33) (1980).

8 Ramu, M G , Venkataram, B.S., Janakiramaiah, N., Shankara, M.R. & Leelavotliy, S. An approach to mentalexamination based on ayurvedic concepts (Manograph No. 12) Published by C.C.R.A.S., New Delhi (1981).

9 Ramu, M G Senapati, H.M., Janakiramaiah, N., Shankara, M.R., Chaturvedi, D.D. & Narasimha Murthy, N S.A Pilot study on role of Brahmyadiyoga in Chronic Unmada (Schizophrenia), Ancient Science of Life,2(3) : 205-207 (1983).

Publications brought out by NIMHANS

1. Mind Approaches to its Understand-ing, 1978.

2. Psychotherapeutic ProcessesM. Kapur, V. N. Murthy, K. Sathyavati,

R. L. Kapur (Eds) 1979.3. Biomembranes

..

S. V. Talekar, P. Balaram, S. K. Podder& C. H. Khetrapal (Eds) 1978.

4. Silver Jubilee CommemorativeVolume, 1980.

5. Health Science Information ServicesM. Ishwara Bhat & T. K. S. Iyengar(Eds) 1980.

6. Proceedings of the National Seminaron Neurooncology

D. H. Despande, C. Vidyasagar &G.N. Narayana Reddy (Eds) 1981.

7. NilvIHANS at a Glance, 1982.8. Proceedings of the First National Semi-

nar on NeuroanaesthesiaG. N. Narayana Reddy, S. Malathi,

Hemant Sane, G. Parameswara, R. Ra-mani, & G.S. Umamaheswara Rao(Eds) 1983.

9. ICMR Advanced Centre for Researchon Community Mental Health, 1984.

10. Profiles of Research in Neurosciencesin India, 1984.

11. NIMHANS JOURNAL (Biannual)Vol. 1, Nos 1 and 2, 1983Vol. 2, Nos 1 and 2, 1984.

12. Calendar of Events (Annual)1982, 1983, 1984.

13. NIMHANS NEWS (Fortnightly)1982, 1983, 1984.

93 1 1 5

-M/s.1. V. Raniesh,

. 2. Munireddy3. H. N. Iyengar4. Sri K. Padmanabhan5. Smt. K. Ambujabai6. Sri Divekar7. Resella8. Sri Rama Temple9. Bharani Agencies

10. Goodwill Agencies11. Mico Group12. Dalagnel.Choultry Trust13. Raghavendra Scrap Metal Work14. Boggaram Trust15. Raghavendra Setty & Sons16. Bangalore City Motors Owners Consu-

mers' Co-op. Society17. Central Social Welfare Board

Donors to Relatives' Rest House

M/s.1. B. V. Sivaramaiah2. A. S. Chinnaswamy Raju3. B. V. Rathnaiah Setty4. Chakrapani Chettiar5. Pathi Shank '7anarayana6. K. P. Padmanabha7. M. R. Rangarathnam8. Lakshmipath:.9. O. S. Gupta

18. M. M. Industrial Estate19. Karnataka Silk Marketing Board20. Mysore Minerals Limited21. Mysore Sales International Ltd.22. Hutti Gold Mines Co. Ltd.23. Karnataka Silk Marketing Board Ltd.24. The Chief Executive Officer,

Kanakapura Taluk25. Thungabhadra Minerals Ltd.26. Kirloskar Electric Co. Ltd.27. Karnataka State Small Industries

Development Corporation Limited28. Raghavendra Soapnut Works29. Kuchalambal Charities30. Pathi Adinarayanaiah &

Kamakshiamma Charitable Trust31. Rajarathnam Shetty & Sons32. V. N. Sathyanarayana33. Ramabharati Textiles34. Bhoruka Steel Limited

M/s.10. V. N. Sathyanarayana11. B. V. Aswathaiah12. R. A. Varadaraj13. S. N. Agarwal14. R. D. Girangal15. Govindaraju16. Sai Financiers17. Rajarathnam Shetty & Sons

Organisation Chart of NIMHANS

GOVERNING BODY

FinanceCommittee

AcadeniicCommittee

RehabilitationCommittee

Building &Works Committee

DIRECTOR I

Departments/DivisionsPsychiatryClinical PsychologyPsychiatric Social WorkNeurologyNeurosurgeryNeuropathologyNeurarcdiologyNeuroanaesthesiaMicrobiologyNursingSpeech PathologyAyurvedic Research UnitNeurophyslologyAnimal Research LaboratoryNeurochemistryNeurovirologyBiophysicsBlostaUsticsPublicationsMedical Illustrations & Audio

Visual AidsLibrary & information ServicesBiomedical Engineering &

instrument works

MedicalSuperintendent

ChiefNursingOfficer

ChiefAdministrative

Officer

AccountsOfficer

AdministrativeOfficer

AssistantExecutiveEngineer

A.A.0 AA.0 AA.0(Hospital) (Stores) (Claims)

117

Governing Body of NIMHANS

ChairmanUnion Minister for Health & Family Welfare

Vice-Chairman

The Health Minister, Government of Karnat . tta

Members

The Secretary, Minister of Health & Family Welfare,Government of India or his nominee

The Director General of Health Services,Government of India

The Joint Secretary & Financial Adviser,Ministry of Health & Fatally Welfare,Government of India

The Health Secretary,Government of Karnataka

The Finance Secretary,Government of Karnataka

The Director General,Indian Council of Medical Research

The Vice-Chancellor, Bangalore University

The Director of Medical Education,Government of Karnataka

Four Faculty Members of the National Institute of Mental Healthand Neuro Sciences (nominated by rotation)

One nominee of the ChairmanOne nominee of the Vice-Chairman

Member/Secretary

The Director, National Institute of Mental Health & Neuro Sciences,Bangalore.

118

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