there is a strong need for analyzing the functioning of these clinics so that one can improve them .
a literature search regarding indian studies revealed only one study in a private practice set - up in 1972 .
to analyze the diagnostic distribution of the clients attending the clinic and to study the pattern of follow - up .
the author is running a private psychiatric clinic , and the records of the patients coming to the clinic were maintained .
a description of the private practice set - up of the author can be provided on request .
these years have been chosen because these were the first 2 years when full records were maintained .
the record keeping was started in mid-1996 . as these records were maintained for clinical purposes , the information available in each case record was not uniform .
no scales were used , and these could be taken as subjective assessment of the patients , their caretakers and the clinician .
these years have been chosen because these were the first 2 years when full records were maintained .
the record keeping was started in mid-1996 . as these records were maintained for clinical purposes , the information available in each case record was not uniform .
no scales were used , and these could be taken as subjective assessment of the patients , their caretakers and the clinician .
the total number of patients seen during the study period was 3077 , but 29 records was missing and hence 3048 patients were analyzed .
level of education revealed that 4% were illiterate , 31% had 110 years of education , 44% had 1114 years of schooling and 21% were post - graduates .
this data very clearly reveals that the major load of clinical work in a private psychiatric set - up constitutes of affective disorders and other minor psychiatric disorders while schizophrenia with acute psychosis constitutes 20% of the work load only . 

all anxiety disorders were 4.5%percentages were not calculated for other categories as the numbers were small 
  all anxiety disorders were 4.5% percentages were not calculated for other categories as the numbers were small nearly 50% of the patients dropped out after one visit while another 16% did so after the second visit , 7% after the third visit and 27% attended more than three visits .
these figures are quite alarming because more than 75% of the patients stopped coming after the third visit .
differential pattern of drop out for different disorders has also been provided in table 1 . to understand this differential pattern ,
one will have to take into account the improvement rate for different disorders within the first three visits .
sixty - eight percent patients of schizophrenia , 71% of affective disorders and 76% of dissociative disorder patients reported subjective improvement .
the findings of one private practice set - up may not be generalizable to others as this was more of a tertiary - level private clinic where people came from long distances for an opinion .
these disorders are very disabling and are usually accepted as psychological by medical professionals and hence reach a psychiatric clinic easily . on the other hand , anxiety disorders , panic disorders ,
phobia and other minor psychiatric problems that are much more common in the community do not reach a psychiatric clinic as most of these are managed by non - psychiatric physicians and the public avoids consulting a psychiatrist for these disorders .
the pattern of patients in the clinic should also decide the pattern of education in psychiatric post - graduation .
a study performed in 1972 from lucknow reported that schizophrenia constituted 27.2% in private clinics and 31.3% in hospitals , and depression was 34.3% in private clinics and18.2% in hospitals , respectively .
this is largely due to the fact that minor mental health problems also reach the clinic in current times .
the time is not far when minor psychiatric illnesses will form the bulk of psychiatric practice , and it may be happening even now in large metros .
one of the most worrying aspects of this study is the high drop out rate after one visit .
devenathan reported a drop out rate of 53% after the first visit from a private clinic in bangalore .
the bangalore clinic has much a smaller total attendance and the psychiatrist spends much more time per patient .
could the drop out rate be a reflection of cultural acceptance of mental disorders in this country ?
most people reach a mental health facility after traveling long distances and they have to pay for travel , doctor 's fee and the drugs .
the middle and poor class find that treatment expenses can be met only after curtailing other essential expanses .
under such circumstances , people go to a doctor only when the disease produces palpable discomfort and the treatment is given up as soon as there is relief from the discomfort .
shamsunder commented that while medicines are given free in his hospital for 12 months , yet the patients come only when they can spare time from other pressing chores or when the illness is too disturbing .
economic factors , distance from clinic etc . have often been considered as key factors responsible for treatment discontinuation .
they may play a role but there appear to be other factors that are responsible for treatment stoppage .
the non - adherence rates in schizophrenia in published works vary from 10% to 76% , with a mean of 41% . however , the non - adherence rates in these studies are not comparable as they were mainly concerned with prescription compliance . what is more interesting is that most of these studies were carried out in the west , where treatment is usually free , yet the non - compliance rates were so high .
indian patients are taking treatment on their own , and yet a large number were compliant .
the patients suffering from diseases like schizophrenia , where symptoms are more severe and disturbing , tend to persist with treatment longer than illnesses where symptoms are more understandable and tend to be relieved more easily .
it could be worthwhile to employ one or two local people who could be asked to visit people who have dropped out and try to understand their problems .
lastly , it is recommended that analysis of case records in different types of set - ups should be carried out so that one could understand the nuances of psychiatric practice .
the case records of one private clinic have been analyzed for the period from 1 april 1997 to 31 march 1999 .
diagnostic distribution revealed the following : schizophrenia 20% , affective disorders 40% , ocd 8% , dissociative disorders 6% and anxiety and related disorders of around 4% .
the pattern of visits revealed that 50% of the patients dropped out after the first visit .
considering the drop out rates according to the diagnosis , one observes that there was a 35% drop out after the first visit in schizophrenia , 45% in affective disorders , 44% in ocd and 63.5% in dissociative disorders .
 background : private psychiatric clinics provide help for the bulk of our population , but they have not been evaluated systematically . it is time that we analyze the functioning of these set - ups to improve functioning . 
 this paper is a modest attempt to analyze one such clinic.aims:to analyze the diagnostic distribution of the clients attending the clinic and to study the pattern of follow-up.materials and methods : all records from april 1st 1997 to 31st march 1999 were analyzed . 
 this is a descriptive study.results and conclusions : a total of 3077 new patients visited the clinic in this period . 
 the male : female ratio was 54:46 . 
 diagnostic distribution revealed the following : schizophrenia 20% , affective disorders 40% , ocd 8% , dissociative disorders 5.5% and anxiety disorders around 4.5% . 
 the pattern of visits revealed that 50% of the patients dropped out after the first visit . 
 another 25% did so in next the two visits . 
INTRODUCTION
AIMS AND OBJECTIVES
MATERIALS AND METHODS
Analysis of the data
RESULTS
DISCUSSION
CONCLUSIONS