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ABSTRACT  
Year : 2016  |  Volume : 58  |  Issue : 5  |  Page : 5-9
Award Papers



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Date of Web Publication19-Jan-2016
 

How to cite this article:
. Award Papers. Indian J Psychiatry 2016;58, Suppl S1:5-9

How to cite this URL:
. Award Papers. Indian J Psychiatry [serial online] 2016 [cited 2020 Feb 25];58, Suppl S1:5-9. Available from: http://www.indianjpsychiatry.org/text.asp?2016/58/5/5/174361



   Marfatia Award Top


A 24 Weeks Prospective Study to Assess Cost-Efficacy and Compliance of Antidepressants Among Rural Population

(P.A.C.E. C.A.R STUDY)


T. S. Sathyanarayana Rao, M. S. Darshan , Chittaranjan Andrade

Department of Psychiatry, JSS Medical College & Hospital, JSS University, Mysore. E-mail: tssrao19@yahoo.com

Background and Objectives: Depression and anxiety disorders are posing a substantial burden by rising costs. Pharmoeconomics looks at cost effectiveness of interventions. The study was designed to assess the acceptability, tolerability, discontinuation rates, reasons for noncompliance and cost effectiveness of various antidepressants in a south Indian rural population.

Methodology: A 24 weeks follow up prospective study was designed on subjects (N=455) being evaluated once every 4 weeks on fluoxetine, escitalopram, sertraline, desvenlafaxine, duloxetine, amitryptiline and clomipramine.

Results: Maximum number discontinued medications in the first 4 weeks, and who continued taking medication for the first 12 weeks, continued to take medications for the next 12 weeks. The highest completion rates was seen with escitalopram and desvenlafaxine and least with amitryptiline and clomipramine. Adverse effects of medication as a major reason for discontinuation. The cost incurred for successfully treating a patient for 24 weeks was approximately 2200 rupees on SSRIs, 3200 rupees on SNRIs compared to 7500 rupees on tricyclics.

Conclusion: Though unit cost of SSRIs and SNRIs are more expensive, considering recovery they are much better choice providing effective treatment which is cost effective.

Keywords: Cost-effective antidepressant, SSRI, SNRI, Tricyclics, Primary Health Centre, pharmacoeconomics of antidepressants.

Suicidal Behaviour: What's the Brain up to?

18 F-flurodeoxyglucose Positron Emission Tomography to Study Resting Regional Cerebral glucose metabolism in Patients with Suicidal Behaviour.


Shubhangi Parkar, Natasha Kate

Department of Psychiatry, G.S.Medical College and King Edward Memorial hospital,Parel, Mumbai 400,012 India. E-mail: psubhangi@gmail.com

Background: Individuals with suicidal behaviours are increasingly recognized as having impairments in brain metabolism. However, these are not well delineated.

Aim: To evaluate regional cerebral glucose metabolism (rCMRglu) in subjects with suicidal behaviours and assess differences in rCMRglu between depressed and non-depressed suicidal subjects.

Methods: Thirty-three subject with suicidal behaviours were assessed using Columbia Suicide Severity Rating scale (CSSRS) and Beck's Depression Inventory (BDI). Brain metabolism was assessed using (F18) Fluoro-Deoxy-Glucose Position Emission Tomography (FDGPET).

Results: Of 33 subjects, eighteen had depression FDGPET findings revealed that in comparison to mean asymptomatic controls, subjects had decreased rCMRglu in right inferior frontal, left Broca's left inferio lateral and superior lateral temporal, right inferior parietal and left posterior cingulate cortex. Increased rCMRglu was seen in bilateral superior and medical frontal, right inferior lateral and posterior medical temporal cortex, and midbrain. CSSRS total intensity inversely correlated with rCMRglu in medical frontal cortex, left Broca's and superior lateral temporal cortex and directly correlated with rCMRglu in right cerebellum. There was no significant difference in rCMRglu between depressed and non depressed group.

Conclusion: Significant differences exist in rCMRglu if suicidal individuals, chiefly in frontal and temporal regions. Understanding these would help us identify individuals more at risk for suicidal behaviours.

Keywords: Suicidal behaviour, rCMRglu, Columbia Suicide Severity Rating scale (CSSRS), inferio lateral and superior lateral.

Significance of Serum Cytokines Estimation in First episode Depression & the Implication following Treatment with Conventional Antidepressants

Kshirod K Mishra

Department of Psychiatry, MGIMS, Sevagram, E-mail: drkkmishra2003@yahoo.co.uk

Background: Depression is associated with an acute phase response and increase in production of cytokines primarily proinflammatory types.

Aim: The study was aimed at finding the serum level of pro inflammatory cytokines in patients of 1 st episode depression in comparison to healthy control and to compare the level after treatment with conventional antidepressants.

Patients and Methods: Fifty consecutive cases of first episode depressive patient diagnosed by trained psychiatrist as per ICD-10 diagnostic criteria were included in the study based on purposive sampling. They were compared with equal number of age and sex matched healthy control. Subjects were evaluated clinically using a semi structured Performa. They were administered Hamilton rating scale for Depression (HAM-D) to quantity the severity of depression and Beck's Scale for Suicide Inventory (BSI) to exclude any case with suicidal ideation. Five ml blood sample was collected from cases and control for estimation of serum cytokines prior to starting antidepressants medications to cases. The psychometric tests were repeated for the cases at 6 weeks and 6 months after the treatment with conventional antidepressants. Repeat blood samples for the serum cytokines estimation were also collected at the point. Levels of IL-1β, IL-6 and TNF α was estimated by ELISA techniques using human cytokines kits. The values obtained were statistically analysed using SPSS version 10.0.

Results: Analysis of data showed significant higher values of cytokines mainly for IL-6 and TNF α in depressive patients in comparison to healthy control. The difference was significant at P<0.05 and p<0.001. There are significant reduction in the levels of cytokines, following treatment with antidepressant.

Conclusion: There is a definite rise in the levels of pro inflammatory cytokines in depressed patients, which reduced substantially following treatment with conventional antidepressants. This will open the gate for further research in this area among the Indian population.

Keywords: Depression, Cytokines, antidepressant.

A study of Blood Biomarkers and its Predictive Value In Treatment Resistant Depression

Pankaj Borade

Aim:
  1. To assess the serum levels of biochemical and endocrinological markers in the patients of treatment resistant depression.
  2. To study the correlation of biochemical and endocrinological profiles in the patients of treatment responsive depression and treatment resistant depression.
  3. To ascertain the correlation of sociodemographic characteristics in the patients of treatment resistant depression.


Method: A cross sectional study done in the department of psychiatry SMS Medical College, Jaipur and Psychiatric Centre Jaipur. A total 431 follow up patients who were diagnosed as depression and treated were screened, of which 75 completed the study. The diagnosed depression was done according to ICD-10 criteria. Hamilton Rating Scale for Depression (HAMD 17) item was used to assess the severity of depression. The subjects with score equal to or less than 7 were considered in remission, and were included in treatment responsive group. Subjects with HAMD more than 7 and fulfilling the criteria of current Major depressive episode, despite of being on treatment with two different classes of antideprassants for a duration of 6 to 13 weeks each, and with adequate drug dose were considered treatment resistant and were included in treatment resistant depression group. The subjects underwent laboratory assessment for their biochemical and endocrinological profile, the outcome of which were then analysed using independent t-test, chi square test and linear regression analysis. Sociodemographic characteristics were also studied.

Result: A Significant correlation was found in the levels of TSH, Serum Cortisol, total cholesterol, LDL, HDL, and Sr. Folate with treatment resistant group.

Conclusion: The study emphasises the significance and predictive value of laboratory biomarkers in the management of treatment resistant depression.

Keywords: Endocrinological, antidepressant, HAMD 17, TSH.


   Bombay Psychiatrist Society Award Top


Clinical Correlates of Suicide in Suicidal Patients with Schizophrenia Spectrum Disorders and Affective Disorders

Hemendra Singh, Department of Psychiatry, M.S. Ramaiaha Medical College, Bengaluru, hemendradoc2010@gmail.com

Context:
The most common psychiatric illnesses in the background of suicide are schizophrenia spectrum disorders (SSD) and affective disorders (AD). While depression and hopelessness are important factors for suicide in psychiatric patients, the role of psychotic symptoms is unclear.

Aims: To examine the comparative differences in the clinical correlates of suicide in SSD and AD patients with suicidal risk.

Methods and Material: One hundred and twenty suicidal psychiatric patients (aged between 17-60 years) were evaluated for depression severity, hopelessness, past attempts, and reasons for wanting to commit suicide at the emergency psychiatry centre. Of these 29% had SSD, 65% AD, and 6% other disorders.

Results: Lifetime history of suicide attempts and suicide attempts in previous month were higher in SSD patients. Mean Beck Depression scores, Hopelessness, and Suicide intention scores were significantly lower in patients with SSD as compared to AD (p = < 0.05). More than 60% patients with SSD attributed psychotic symptoms as a reason for wanting to commit suicide, while more than 50% patients with AD attributed it to family and personal stressors (P = < 0.001).

Conclusions: Factors associated with suicidal ideations were significantly different between SSD and AD patients. Hence, suicide prevention strategies should be based on the specific risk factors for each group, SSD and AD.

Keywords: Schizophrenia spectrum disorders, affective disorders, suicide attempts, emergency psychiatry

Quantitative EEG correlates of empathy in Schizophrenia

Asha Krishanan

Central Institute of Psychiatry, Kanke, Ranchi 834006, Jharkand, dr.ashakrishnan@gmail.com

Background: Deficits in empathy as evidenced by impaired mu wave suppression and altered gamma band activity have been demonstrated in schizophrenia indicating impairment in social cognition. Aim of the present study was to study the empathic deficit in schizophrenia using mu-wave suppression and gamma band activity paradigm in response to visually observed social interaction task.

Methods: Fifteen each of schizophrenia patients and controls were assessed for empathy using Interpersonal Reactivity Index (IRI). The psychopathology of schizophrenia patient group was assessed using PAN SS. All the subjects underwent 256 channel EEG recording while viewing social interaction task. Spectral power of mu (8=l3 Hz) and gamma bands (30-100 Hz) were estimated using Welch's averaged periodogram method. Mu wave suppression was calculated using the equation: Mu activity = log l0 (mu power of biological motion condition / mu power of noise condition). A log ratio less than zero indicated mu suppression, equal to zero indicated lack of mu wave suppression and greater than zero indicated mu enhancement.

Results: Reduced scores were found on in the schizophrenia patients compared to healthy control group. While there was no significant difference in mu wave suppression, significantly higher social interaction task induced gamma spectral power was found in schizophrenia patients compared to healthy control. Significant correlation was found between gamma spectral power and empathy scores on IRI.

Conclusion: Our study proposes a role of social interaction task induced gamma band activity as a biomarker for empathy and more specifically imply higher order mirror neuron activity.

Keywords: Schizophrenia, Empathy. Mirror neurons, Mu suppression. Gamma activity.

Associations of Metabolic Syndrome with Elevated Liver Enzymes and C-reactive Protein in Drug Naive Patients with Depressive Disorders

Naresh Nebhinani

Department of Psychiatry, AIIMS, Jodhpur, Rajasthan, drnaresh_pgi@yahoo.com

Background and aim: Metabolic syndrome (MS) is found to be more prevalent in patients with depression. As there is lack of Indian data, this study aimed to assess the prevalence of MS and its association with liver enzymes and C-reactive protein (CRP) in drug naive patients with Depressive disorders.

Methods: Prevalence of MS was assessed in one hundred seventy patients with depressive disorders and thirty healthy controls by using Modified NCEP ATP-lII Criteria. Liver enzymes and CRP were also assessed for patient group.

Results: MS Prevalence was 25.9% in patients with depression, which was higher than the healthy controls (17.3%). Lower HDL level was the commonest abnormality in depression group. Compared to healthy controls, significantly greater proportion of patients with depression had abnormal fasting blood sugar, and HDL levels. Besides MS another 61% fulfilled one or two criteria of MS. Significant predictors of MS were age, duration of psychiatric illness, body mass index, obesity, GGT and CRP levels.

Conclusions: One-fourth of depressed patients had MS and another three-fifth of patients had one or two metabolic abnormalities and these were associated with greater GGT and CRP levels. Patients with depression should be regularly evaluated and timely treated for cardiovascular risk factors.

Keywords: Metabolic syndrome, liver enzymes, inflammatory makers, depression, India

Neuropsychological Predictors and Structural MRI in Relation to Mild Cognitive Impairment: 1 Year Longitudinal Study

Ashish Chepure

Maharastra, ashu.chepure@gmail.com

lntroduction: Mild Cognitive Impairment (MCI) poses 10-15% risk of progression to Alzheimer's disease (AD) with neuropsychological, behavioural deficits and changes in hippocampal volumes on MRI. These changes suggestive of AD if detected earlier using longitudinal assessments using neuropsychological tests and MRI, possible intervention can be done to prevent progression to AD. The purpose of this study is to assess factors in relation to the diagnosis of MCI among Indian elderly, and to follow them onto progression to Alzheimer's disease.

Aims and objectives: Aim of the study was to assess cognition and behavioural symptoms with the help of Neuropsychological tests and MRI brain findings in patients with MCI and healthy controls. Objective of the study was to assess percentage of MCI patients who converted into Alzheimer's disease after 12 months of follow-up and correlation of MRI findings with neuropsychological and behavioural evaluation parameters.

Material and methods: 78 consenting elderly (above 60 years) were divided into MCI and HC groups as per inclusion and exclusion criteria and assessed longitudinally over 12 months in 3 visits using Addenbrook's cognitive examination (ACE), MMSE, Clinical Dementia Rating Scale (CDR), Behavioural Pathology In AIzheimer's Disease (BEHAVE-AD) And MRI Brain. Right and left hippocampus and total intracranial volumes (TICV) were obtained by using software MYRIAN by volumetric analysis. Date obtained was analyzed statistically.

Results: Age and educational background of MCI stable and HC group was comparable. Longitudinally both groups showed significant difference across all cognitive parameters except registration on ACE with MCI stable group showing poor performance across total ACE scores, MMSE scores and Global CDR scores than HC group. MCI stable group showed significantly higher scores in BEHAVE-AD assessment than HC group. MCI stable group had significantly lower Normalized Right and Left hippocampal volumes and TICV at baseline as well as at 1 year than HCs. MCI stable group showed significant reduction in right and left hippocampal volumes and total intracranial volumes across 1 year. 2 MCI participants converted to AD in one year and had significantly low scores across memory domains of neuropsychological tests and low total ACE, MMSE, higher Global CDR scores and smaller hippocampal volumes than MCI stable group and faster rate of decline.

Reduction in Episodic memory, immediate recall and increase in Global CDR scores were correlated with reduction in hippocampal volumes longitudinally.

Conclusion: MCI can be diagnosed easily using MCI criteria, reduction in neuropsychological test scores like ACE and subtle MRI brain volumetric changes longitudinally. Behavioural symptoms point towards mild behavioural impairment along with MCI. Risk of progression to AD may be identified by worsening in cognitive, behavioural and MRI parameters. The high rate of progression of MCI emphasizes the need for early identification and intervention to prevent progression to AD.

Keywords: Mild cognitive impairment (MCI), Addenbroke's cognitive examination (ACE), mild behavioural impairment, MRI, volumetric analysis


   Young Psychiatrist Award Top


A Study of Gender Differences in Psychiatric Patients with Attempted Suicide

Hemendra Singh 1 , Prabha S Chandra 2 , V. Senthil Kumar Reddi 2

1M. S. Ramaiah Medical college, Bangalore-560054;

2 National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore-560029

Introduction: Various studies have attributed gender based differences of suicidal behavior to various socio-demographic factors; however there is need to study of the various clinical factors associated with gender based differences in psychiatric patients with suicide attempt.

Aim: To investigate the gender differences in psychiatric patients with attempted suicide.

Methods: One hundred eleven patients with current suicide attempt were evaluated for depression severity, hopelessness, suicide ideations, suicide intent, past attempts, both suicidal and non-suicidal self-injury (NSSI), and psychotic symptoms.

Results: The diagnostic breakup was e 30.6% schizophrenia spectrum disorders (SSD), 63.1% affective disorders (AD), and 6.3% other disorders. Over 60% of the suicide attempters were females. The most frequent reason given for attempting suicide was psychiatric illness in case of females, 32.9%, and psychotic symptoms, 28.5% in case of males. The number of suicide attempts and frequency of NSSI were in a higher range for females as compared with males. No significant differences were found in Beck Depression severity, hopelessness, suicide ideation, and suicide intent between males and females. Females used non-lethal methods (p = 0.022), as compared to males in patients with AD.

Conclusions: Female suicide attempters were more than male suicide attempters, and the number of suicide attempts and the frequency of NSSl too were in a higher range for females. The most frequent reason for attempting suicide was different between females and males. Because attempted suicide is a risk-factor for suicide at a later date, the implications of these gender-specific differences for clinical practice must be taken into consideration while framing measures for suicide prevention.

Measuring Catatonia Using four Different Instruments: Inter-rater Reliability and Prevalence in Clinical Population

Siddharth Sarkar

AIIMS, New Delhi

Background and aims:
The present study aimed to assess inter-rater reliability and prevalence of catatonia according to four diagnostic methods, i.e, Bush Francis Catatonia Rating Scale (BFCRS) both screening and complete scale, Braunig's Catatonia Rating Scale (CRS), ICD 10 and DSM5.

Methods: For inter-rater reliability, different raters evaluated patients using the definitions provides by the four scales: BFCRS Screen and Total, CRS, ICD10 and DSM5. Kippendorff alpha was used to compute the inter-rater reliability. Prevalence of catatonia was studied using the four definitions in a clinical sample of consecutive adult admissions a psychiatry ward of a tertiary care hospital.

Results: The inter-rater reliability was found to be good for BFCRS Total (alpha = 0.779), moderate for DSM5 and BFCRS screen (alpha = 0.575 and alpha = 0.514 respectively) and low for CRS and ICID10 (alpha = 0.111 and alpha = 0.018 respectively). BFCRS Total and DSM5 definitions of catatonia had highest correlation with each other (rs = 0.892 p <0,001). In the prevalence sample of consecutive hospital admissions, the prevalence was found to be highest with the definitions of BFCRS Screen and ICD 10 (10.3%, confidence intervals [CI] 3.9% to 16.7% for both), followed by BFCRS Total and DSM5 definitions (6.9%, CI 1.6% to 12.2% for both) and while CRS yielded the lowest prevalence rate (3.4%, CI 0% to 7.2%).

Conclusion: Different methods used to determine catatonia in the clinical sample yield different prevalence of this condition. Inter-rater reliability seems to best for BFCRS.

Keywords: Catatonia, diagnosis, ICD10, DSM5

Vitamin D Deficiency and Cardio-Metabolic Risk in Patients with Depressive disorders and Healthy controls: A Comparative Study

Naresh Nebhinani

Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan, 342005. E-mail: drnaresh_pgi@yahoo.com

Background and Aim: It has been hypothesized that hypovitaminosis D is associated with depression and Metabolic syndrome (MS) but world literature is sparse and lack of Indian data in this regard. Hence index study was aimed to assess the association among vitamin D, cardiometabolic risk and depression in patients with depressive disorders.

Methods: One hundred fifty-two patients with depressive disorders and thirty healthy controls were assessed for MS by using Modified NCEP-ATP-III Criteria and for serum 25- hj/droxyvitamin D3 level. Patients were also assessed for severity of depression, physical activity and nutritional habits.

Results: One-fourth of patients (25%) had MS, while two-third of patients (62%) had one or two metabolic abnormalities, with the commonest metabolic abnormality of lower HDL level (71%). Compared to healthy controls, significantly greater proportion of patients (87.5%) had vitamin D deficiency (<20 ng/ml) with mean vitamin D level of 11.7 ng/ml (p<0.00l). Predictors of hf/povitaminosis D were gender, employment and height (with more deficiency in smaller, unemployed, and females). Hypovitaminosis D was not associated with age, education, locality, obesity, metabolic abnormalities, MS, severity of depression, sun exposure, physical exercise and nutrition habits.

Conclusions: Nearly one-fourth of depressed patients had MS and other two-third had one or two metabolic abnormalities. Index study indicates that hypovitaminosis D was associated with the depression suggesting that its potential role in underlying biological vulnerability for depression. Future studies should elucidate whether the vitamin D supplementation could be cost effective as part of preventive or treatment interventions for depression.

Keywords: Vitamin D, hypovitaminosis D, cardiometabolic risk, metabolic syndrome, depression. India


   Bhagawat Award Top


Discorded 'Self' in Schizophrenia: A Neuroscience Evaluation of the Effects of MRI Navigated Magnetic Stimulation

Sai Krishna Tikka.

Ranchi

Aim: Using comprehensive neuro- scientific assessments, this study assesses disordered " self" in schizophrenia and investigates the effect of repetitive transcranial magnetic stimulation ( + TMS) of right inferior parietal loble (rIPL).

Methods: Twenty schizophrenia patients with first rank symptoms ( FRS , FRS +) 20 patients without FRS ( FRS +) and 20 healthy controls (HC) were assessed for psychopathology, especially designed FRS score sheets. Resting state electroencephalography was aquiredusing 256 electrodes: gamma spectral -power was measured in regions of interest. Serum BDNF and self- monitoring were also assessed FRS+ group randomly received either active or sham-MRI navigated continuous theta-burst stimulation (cTBS) - rTMS to rPL for 2 weeks, assessments were repeated.

Results: At baseline, FRS+ group showed significantly increased gamma spectra power, especially on right hemispheric regions, along with lower BDNF levels and lower scores on self monitoring compared to FRS- and HC significant difference over time was found only on PANSS positive syndrome scores and gamma power in right superior temporal gyrus (STG). However no time and group interaction was found on any of the variables.

Conclusions: Schezophrenia patients fulfilling the criteria of presence of first rank symptoms represent a distant neurodevelopmental subgroup with associated features of predominantly positive symptoms significantly lower neurotrophin levels, aberrant resting state brain activity in the heteromodal association cortex and perform poorer on self monitoring tasks. cTBS to rIPL as an adjunct in the acute phase treatment is found not to effective in this group.

Keywords: Schizophrenia, self-disorders, gamma spectral power, self monitoring, BDNF, inferior parietal lobule, neuronavigated theta burst r TMS.

A Prospective Study of Psychiatric Morbidity, Cognitive Functions and Quality of Life in Post Surgical Patients of Low-grade Gliomas: The impact of adjuvant Treatment

Pulkit Kaushal

Mumbai

Background: The most common primary brain tumors are gliomas. Both the treatment and the tumors can cause disabling morbidity. This morbidity coupled with impending fear of death could lead to psychiatric complications. Of the gliomas, Low grade glioma ( LGG) patients have a longer survival period. Living with the malignancy has been reported to cause psychiatric morbidity and cognitive problems which could lead to a decrease in quality of life (QOL). Raditherapy as a treatment has shown to prolong progression free survival but has been reported to have its own detrimental effect on cognition and depression.

Aim : To study psychiatric morbidity (depression and anxiety), quality of life and cognition. In post surgical patients of low grade glioma. To compare the changes in these variables after 3 months of observation or post- radiation.

Material and Methods: It was a prospective, observational study of 30 post-operative LGG patients, Baseline evaluation of psychiatry variables was done by Hospital Anxiety and Depression Scale (HADS). Weschler Memory scale and Digital Symbol Substitution Test(DSST) was used to study cognition Quality of life was evaluated by European Organisation for Research and Treatment for Cancer (EORTC) QLQC-C30 and Brain Cancer Module (BN-20) Patients after surgery, received either observation or radiotherapy depending upon treating Unit's protocol. Second assessment was done at 3 months.

Key words: Gliomas, Radiotherapy, DSST, Brain cancer.

Reasons for Pursuing Psychiatry as a Career: A Qualitative Study of Indian Postgraduate Psychiatry Students

Priya Sreedaran

Bengaluru

Context: Literature in India lacks clarity regarding the reasons for which medical graduates select psychiatry.

Aims: To explore the experiences of postgraduate psychiatry students with respect to their reasons for choosing psychiatry.

Settings: In Indian medical college with a psychiatry postgraduate programme.

Methods and Materials: A qualitative study using focus group discussions and in-depth interviews with post graduate psychiatry residents.

Statistical analysis: Content analysis was used to identify direct and latent themes and develop a model.

Results: The reasons for choosing psychiatry are categorized into five types which include candidate related factors, medical college related factors and those related to process of Indian postgraduate medical selection.

Conclusion: In India, candidate related factors, candidates experiences of psychiatry during their medical college, the current system of postgraduate medical selection, along with factors associated with psychiatry as a subject and social factors appear to serve as prominent reasons for students opting for psychiatry as a career.

Key message: In addition to improving quality of undergraduate psychiatry teaching, it is necessary to systematically engage with potentially interested medical students, in order to improve future psychiatry recruitment rates.

Key words: Postgraduate, Psychiatry, medical education, medical graduates, recruitment, career.

Investigating Spontaneous Brain activity in Bipolar Disorder Type 1: A Resting state Functional MRI Study

Rashmin Achalia

Aurangabad

Background: Although decades of efforts have spent studying the pathogenesis of bipolar disorder type 1 (1 BD), there are still no objective biological markers that could be reliably used to identify individuals with BD. Hence we used resting state functional magnetic resonance (RS-MRI) imaging to detect spontaneous brain activity in patients with BD.

Aims: We used regional homogeneity (ReHo) approach using RS-fMRI to investigate patients with bipolar disorder type 1 (BD) compared to age and gender matched healthy control.

Methodology: 20 patients with BD and 20 age, gender and education matched healthy controls participated in the study. The MRI data was obtained using 1.5 T scanner RS-fMRI. Abnormalities were analysed using ReHo method.

Results: Compared to healthy adults significantly increased ReHo in the BD group was found in the right precuneus, right insula, right suprmarginal gyrus, left superior frontal gyrus. Right interior frontal gyrus. Right precentral gyrus, and right paracentral lobule. No region had significantly lower ReHo values in BD patients compared to controls.

Conclusions: These results suggested that abnormal local synchronization of spontaneous brain activity is present in fronto-parieto-insular region which may be related to the pathophysiology of BD

Keywords: Bipolar Disorder, ReHo, MRI

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