(Current Medical Practice (1993): (37), 6, 121-125) 

A.A. Quadri, M.B.,B.S., D.P.M., F.I.P.S.
Consulting Neuro Psychiatrist, Mental Health Clinic
Near University Gate, Aurangabad.

(Paper presented at 45th Annual National Conference of the
Indian Psychiatric Society, Lucknow, on 9.1.1993) 

In recent years there has been an increase in the incidence of behavioural disorders. They constitute a very important segment in psychiatric practice being associated either with normal physical development and intelligence or with mental retardation.

Mental retardation refers to significantly sub-average general intellectual functioning resulting in or associated with concurrent impairments in adaptive behaviours and manifested during the developmental period.

Mental retardation is associated with behavioural problems. Also there may be associated psychiatric disorders. Often it is difficult to classify the behavioural problems into specific diagnostic categories and treat them accordingly.

A child’s behavioural problem represents a conflict between his developing personality and his environment, viz. parents, siblings, teachers. It can be extremely trying both for the parents and the treating physician. Hence it is desirable to have an effective as well as safe drug for management of this problem.

In this setting, a double-blind trial of an Ayurvedic remedy Mentat (BR-16A), which is known to be useful in treating behavioural disorders, was carried out.

Certain groups of isolated symptoms were considered for assessing the effectiveness of Mentat. Mentat contains important plant ingredients such as Jal brahmi (Bacopa monnieri), Madhukaparni (Centell asiatica), Jatamansi (Nardostachys jatamansi), Malkangni (Celastrus paniculatus) etc., besides numerous others which are reputed in Ayurveda, the ancient system of medicine, to be of great value in the management of nervous disorders.

The trial was carried out on 50 out-door patients attending the psychiatric O.P.D. and lasted between September 1990 and July 1992. They were mentally retarded children presenting with behavioural problems.

Patients with mild to moderate degree of retardation, determined clinically and aided by Binet-Kumat test with I.Q. between 54.66 and with a minimum of three behavioural problems, were selected. Detailed clinical history was taken for determining hereditary, pre-natal, natal and post-natal factors. After initial selection, every child was evaluated on a development scale motor emotional, social and learning problems.

After initial assessment the child was given either drug A (Mentat) or drug B (placebo) and rated after every 15 days. The dosage was 2-4 tablets per day depending on the child’s age.

Out of fifty children, thirty received Code A drug and twenty received Code B (an identical-looking placebo). Out of the thirty on Mentat, four cases dropped out during the initial trial period, while out of twenty on placebo, two dropped out during the first month of trial. Every 15 days the child was called for assessment and rated for improvement and also global rating.

The children exhibited a number of emotional, behavioural, social and learning problems. The main symptoms were fear, irritability, temper tantrums, aggression, non-cooperation, unfriendliness, lack of concentration, enuresis, speech defects and fits. Some children were withdrawn, quiet, stubborn, backward in studies and unwilling to learn.

Group A (Mentat) comprised 26 children (after 4 dropouts) in the age group of 4-12 years. Twenty-one were males and 5 were females. Improvement in symptoms was evident after fifteen days, which is highly significant. On global assessment, 22 showed improvement, 2 marked improvement and only 2 did not show any response.

Group B [placebo comprised 18 children (after 2 dropouts)]. None of them showed any improvement and probably because of this, no one continued the drug beyond two months.

A detailed analysis of each symptom with the degree of improvement is given in Tables 1 and 2.

Mental retardation is caused by many aetiological factors. Often the exact cause cannot be detected and as there is no scope for brain development beyond certain limits all that can be done is to make the maximum use of the available potential and make the child socially useful and acceptable.

Of the 16 children in Group A (Mentat) with hyperkinetic behaviour, 14 showed marked improvement, one moderate and only one no improvement. And of 12 cases exhibiting aggressive behaviour, 6 showed marked improvement, 4 moderate and 2 no improvement.

Out of 22 non-cooperative children, 20 improved and cooperated at the end of the trial.

Out of 8 children who were backward in studies, 8 showed marked improvement and 4 no improvement.

Four children displayed improvement in concentration and studies, while two children, who had behavioural problems after control of epilepsy, showed remarkable improvement following use of Mentat. Two patients with enuresis and one with speech defect also showed improvement.

No side-effects were noted during the entire trial period of twenty months. Mentat produced neither sedation nor any extrapyramidal side-effects, which are usually troublesome with conventional drugs.

Compliance with drug intake was very good and hence it can be safely used over a long period of time.

Those who were on Mentat (Group A) maintained consistent improvement over a period of 20 months.

Mentat has proven useful in behavioural problems of children, especially hyperkinetic behaviour associated with mental retardation.

It definitely improves performance and social adaptability in children. So it can be used in combination with other therapy for behavioural modification and achieving control over all social functioning in mentally retarded children.