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   2010| July-September  | Volume 52 | Issue 3  
    Online since October 9, 2010

 
 
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ORIGINAL ARTICLES
Clinical correlates of thalamus volume deficits in anti-psychotic-naïve schizophrenia patients: A 3-Tesla MRI study
Naren P Rao, Sunil Kalmady, Rashmi Arasappa, Ganesan Venkatasubramanian
July-September 2010, 52(3):229-235
DOI:10.4103/0019-5545.70975  PMID:21180407
Background: Thalamus, the sensory and motor gateway to the cortex, plays an important role in cognitive and perceptual disturbances in schizophrenia. Studies examining the volume of the thalamus in schizophrenia have reported conflicting findings due to the presence of potential confounding factors such as low-resolution imaging and anti-psychotics. The thalamus volume in anti-psychotic-naοve patients determined using high-resolution 3-Tesla magnetic resonance imaging (MRI) has not yet been examined. Materials and Methods: Using 3-Tesla MRI, this study for the first time examined anti-psychotic-naοve schizophrenia patients (n=18; M:F:11:7) in comparison with healthy controls (n=19;M:F:9:10) group-matched for age, sex, handedness, education, and socioeconomic status. The volume of the thalamus was measured using a three-dimensional, interactive, semi-automated analysis with good inter-rater and intra-rater reliability. Psychopathology was assessed using the Scale for Assessment of Negative Symptoms (SANS) and the Scale for Assessment of Positive Symptoms (SAPS). Results: Right, left, and total thalamus volumes of patients were significantly smaller than those of controls after controlling for the potential confounding effect of intracranial volume. Thalamus volumes had significant positive correlation with positive symptoms score (SAPS) and significant negative correlation with negative symptoms score (SANS). Conclusions: Thalamus volume deficits in anti-psychotic-naοve schizophrenia patients support a neurodevelopmental pathogenesis. The contrasting correlation of thalamus volume deficits with psychopathology scores suggests that contrasting pruning aberrations underlie symptom genesis in schizophrenia.
  11 5,602 211
Pattern of buprenorphine abuse among opioid abusers in Nepal
Tapas Kumar Aich, Manoj Dhungana, Roshija Khanal
July-September 2010, 52(3):250-253
DOI:10.4103/0019-5545.70978  PMID:21180410
Background : Although buprenorphine abusers are a common clinical entity, literature on them is rare in Nepal. Aim : To assess whether injectable opioid abusers are any different a subgroup vis-a-vis brown sugar abusers in relation to their demographic and clinical profiles. Materials and Methods : Seventy-six opioid abusers, who were admitted over a period of one year, in our de-addiction center, were included in the present study. They were divided into two groups based on the history of the presence or absence of buprenorphine injection abuse in them. The demographic and clinical profiles of these two groups were studied and compared. Results : The most characteristic opioid abuse pattern was the abuse of brown sugar through inhalation (chasing). A total of 32 (42.1%) among them had a history of injectable drug abuse (IDU). Most characteristic buprenorphine abuse pattern seen was an evolution from injectable buprenorphine to triple injection to brown sugar abuse (Reverse Transition). Injection buprenorphine abusers, who attended our clinic, were older in age and had a history of a longer duration of abuse than their counterparts who abused opioid drugs through the inhalational route only. Their lifetime diagnosis revealed a polysubstance abuse pattern. They were more unstable, impulsive, and disorganized in their behavior pattern, suggestive of the presence of inadequate personality traits. There were high instances of injection-related side effects in the form of the presence of thrombophlebitis, HIV positivity, and clinical AIDS in them. Conclusion : Findings of the current research indicate the presence of a subgroup of patient population among opioid abusers with a history of injectable buprenorphine abuse, with characteristic personality traits, pattern of drug abuse, and associated physical complications resulting from it.
  7 2,405 148
Evidence of altered DNA integrity in the brain regions of suicidal victims of Bipolar Depression
Mohammed S Mustak, Muralidhar L Hegde, Athira Dinesh, Gabrielle B Britton, Ruben Berrocal, K Subba Rao, NM Shamasundar, K.S.J Rao, TS Sathyanarayana Rao
July-September 2010, 52(3):220-228
DOI:10.4103/0019-5545.70974  PMID:21180406
Deoxyribonucleic acid (DNA) integrity plays a significant role in cell function. There are limited studies with regard to the role of DNA damage in bipolar affective disorder (BP). In the present study, we have assessed DNA integrity, conformation, and stability in the brain region of bipolar depression (BD) patients (n=10) compared to age-matched controls (n=8). Genomic DNA was isolated from 10 postmortem BD patients' brain regions (frontal cortex, Pons, medulla, thalamus, cerebellum, hypothalamus, Parietal, temporal, occipital lobe, and hippocampus) and from the age-matched control subjects. DNA from the frontal cortex, pons, medulla, and thalamus showed significantly higher number of strand breaks in BD (P <0.01) compared to the age-matched controls. However, DNA from the hippocampus region was intact and did not show any strand breaks. The stability studies also indicated that the melting temperature and ethidium bromide binding pattern were altered in the DNA of BD patients' brain regions, except in the hippocampus. The conformation studies showed B-A or secondary B-DNA conformation (instead of the normal B-DNA) in BD patients' brain regions, with the exception of the hippocampus. The levels of redox metals such as Copper (Cu) and Iron (Fe) were significantly elevated in the brain regions of the sufferers of BD, while the Zinc (Zn) level was decreased. In the hippocampus, there was no change in the Fe or Cu levels, whereas, the Zn level was elevated. There was a clear correlation between Cu and Fe levels versus strand breaks in the brain regions of the BD. To date, as far as we are aware, this is a new comprehensive database on stability and conformations of DNA in different brain regions of patients affected with BD. The biological significance of these findings is discussed here.
  7 3,918 210
CASE REPORTS
Treatment of severe borderline personality disorder with clozapine
Adarsh Kumar Vohra
July-September 2010, 52(3):267-269
DOI:10.4103/0019-5545.70989  PMID:21180415
Patients with borderline personality disorder (BPD) show significant impairment in the domain of interpersonal and social functioning and may use the resources of health and social services extensively, with little beneficial outcome. At present there are no clear guidelines in literature for the use of pharmacotherapy in the management of BPD. According to the scanty literature available in the form of case reports and small studies, clozapine has been demonstrated to be effective in the management of BPD. The case presented here describes the effectiveness of clozapine in a young female patient with severe BPD (without psychotic features), who had repeated and prolonged periods of hospitalization and was successfully treated with a moderate dose of clozapine, following a failure to improve with other psychotropic medications. More studies are suggested to evaluate the efficacy of clozapine in patients with BPD, both with and without psychotic features, to find out the optimum dose and to weigh the risk and benefits of clozapine.
  6 5,420 297
CME
Relevance of psychiatry in dermatology: Present concepts
KH Basavaraj, MA Navya, R Rashmi
July-September 2010, 52(3):270-275
DOI:10.4103/0019-5545.70992  PMID:21180416
Skin is an organ that has a primary function in tactile receptivity and reacts directly upon emotional stimuli. Dermatological practice involves a psychosomatic dimension. A relationship between psychological factors and skin diseases has long been hypothesized. Psychodermatology addresses the interaction between mind and skin. It is divided into three categories according to the relationship between skin diseases and mental disorders. This article reviews different dermatological conditions under each of the three categories namely psychosomatic disorders, dermatological conditions due to primary and secondary psychiatric disorders. Dermatological conditions resulting from psychiatric conditions like stress/depression and those caused by psychiatric disorders are discussed. This review intends to present the relationship between the 'skin' and the 'mind' specifically from the dermatology point of view. The effects on the quality of life as a result of psychodermatological conditions are highlighted. A multidisciplinary approach for treatment from both dermatologic and psychiatric viewpoints are suggested.
  5 4,999 615
REVIEW ARTICLE
Fourth revolution in psychiatry - Addressing comorbidity with chronic physical disorders
Shiv Gautam
July-September 2010, 52(3):213-219
DOI:10.4103/0019-5545.70973  PMID:21180405
The moral treatment of mental patients, Electro Convulsive therapy (ECT), and Psychotropic medications constitute the first, second, and third revolution in psychiatry, respectively. Addressing comorbidities of mental illnesses with chronic physical illnesses will be the fourth revolution in psychiatry. Mind and body are inseparable; there is a bidirectional relationship between psyche and soma, each influencing the other. Plausible biochemical explanations are appearing at an astonishing rate. Psychiatric comorbidity with many chronic physical disorders has remained neglected. Such comorbidity with cardiac, respiratory, Gastrointestinal, endocrinal, and neurological disorders, trauma, and other conditions like HIV and so on, needs to be addressed too. Evidence base of prevalence and causal relationship of psychiatric comorbidities in these disorders has been highlighted and strategies to meet the challenge of comorbidity have been indicated.
  4 3,286 476
BRIEF RESEARCH COMMUNICATION
Anti-psychotic prescription pattern: A preliminary survey of Psychiatrists in India
Sandeep Grover, Ajit Avasthi
July-September 2010, 52(3):257-259
DOI:10.4103/0019-5545.70982  PMID:21180412
Although anti-psychotic medications are available in India since a long time, little is known about the prescription patterns of Indian psychiatrists. An email survey was sent to 1100 psychiatrists, of which 168 responded. The three most commonly prescribed anti-psychotics were risperidone, olanzapine, and haloperidol. It was also found that typical anti-psychotics comprise of 25.15% (SD=21.66; range 0-100) of all prescriptions and in about 22.36% of the cases the psychiatrists were using more than one anti-psychotic in the same patient.
  3 2,121 272
CASE REPORTS
Familial vulnerability to an unusual cognitive adverse effect of topiramate: Discussion of mechanisms
Chittaranjan Andrade, Savita G Bhakta, Praveen P Fernandes
July-September 2010, 52(3):260-263
DOI:10.4103/0019-5545.70986  PMID:21180413
Background: Some patients experience cognitive disturbances with topiramate. Case histories: A 19-year-old bipolar woman and her 46-year-old mother with paranoid personality disorder both used topiramate (25-50 mg/day) off-label for weight loss. Both women suffer from learning disorders, and both are excessively sensitive to the sedative adverse effects of psychotropic medications. Results: Within days of starting topiramate, the women began to exhibit troublesome word- and phrase-repetition and word substitution, both occurring only in their written expression. The symptoms were associated with mild sedation, persisted during two weeks of topiramate treatment, and remitted days after topiramate was withdrawn. Discussion: The presence of the learning disorders and the sensitivity to the sedative adverse effects of drugs may explain why cognitive adverse effects, known to occur with topiramate, developed at the low dose of 25-50 mg/day. The proclivity of topiramate to affect language functions and a possible familial vulnerability herein may explain why the women explained similar, language-specific symptoms. An investigation of topiramate-induced cognitive impairments in family members with epilepsy may throw light on the subject.
  2 1,920 114
GUEST EDITORIAL
Coercion in psychiatric care: Global and Indian perspective
Ruchita Shah, Debasish Basu
July-September 2010, 52(3):203-206
DOI:10.4103/0019-5545.70971  PMID:21180403
  2 2,734 308
ORIGINAL ARTICLES
Cannabis dependence: Effects of cannabis consumption on inter-regional cerebral metabolic relationships in an Indian population
Shubhangi R Parkar, Seethalakshmi Ramanathan, Narendra Nair, Shefali A Batra, Shilpa A Adarkar, Anirudh G Pandit, Purushottam Kund, Nawab Singh Baghel
July-September 2010, 52(3):236-242
DOI:10.4103/0019-5545.70976  PMID:21180408
Background: The effects of cannabis consumption on neurophysiological function have been a matter of considerable debate. With the legalization of medical marijuana, understanding the consequences of cannabis dependence has become extremely important. Aim: We attempted to understand the influence of cannabis on cerebral glucose metabolism in certain predetermined regions of interest (ROIs). Furthermore, we also explored inter-regional metabolic relationships between ROIs forming the "addiction" and "cognitive dysmetria" circuit. Materials and Me thods: 2-fluoro, 2-deoxy-glucose positron emission tomography (FDG PET) scans were carried out in 16 male patients (age: 25.3±10.38 years) with cannabis dependence, 8-12 hours after the last cannabis consumption. Resting glucose uptake in 14 pre-determined ROIs was compared with glucose uptake in 16 non-drug using volunteers (age: 29.2±8.39 years). Results: The two groups differed in their lateral and medial temporal glucose uptakes by approximately 16-24%. The relationships between inter-regional glucose uptakes in the two circuits were compared using the Chow Test. Significant differences in inter-regional correlations in the medial temporo-frontal and parieto-thalamic were noted between the two groups. Conclusion: The altered metabolic relationships among various brain regions can have potentially important implications for understanding cannabis dependence and cannabis-induced psychopathology.
  2 4,307 209
Severity of alcoholism in Indian males: Correlation with age of onset and family history of alcoholism
R Johnson Pradeep, Saira Banu, MV Ashok
July-September 2010, 52(3):243-249
DOI:10.4103/0019-5545.70977  PMID:21180409
Background: Family History of Alcoholism and earlier Age of Onset are found to predict Severity of alcoholism. Previous Indian studies in this regard have methodological issues related to the definition of alcoholism and reliability of information obtained. Aims: To study the relationship between the Age of onset/Family History and Severity of alcoholism. Settings and Design: Consecutively admitted, 20 to 50 year old men, with alcohol-related problems at an urban teaching hospital, were recruited. Materials and Methods: After detoxification, alcohol use detection inventory test, severity of alcohol dependence questionnaire, schedule for clinical assessment in neuropsychiatry, and family interview for genetic studies were administered. Family history density was computed. Statistics: Pearson's correlations, linear regression, and ANOVA tests were used. Results: Family history density and severity of alcoholism were positively correlated. Age of onset of initiation had a significant negative correlation with severity. The effect of family history on the rapidity of development of Problem-drinking did not reach statistical significance among those with early age of onset. The variance explained by the 'family history status' and 'age of onset' for the severity of alcoholism was similar to that reported in earlier western studies. Conclusion: This study, with enhanced methodology, using a general hospital sample of problem drinkers concludes that the age of onset of initiation is a better predictor of severity of alcoholism, than family history of alcoholism alone. Postponing the use of alcohol till the age of 25 years could be explored as a primary prevention strategy in genetically vulnerable adolescents.
  2 4,023 787
EDITORIAL COMMENTARY
Deprivation, discrimination, human rights violation, and mental health of the deprived
RC Jiloha
July-September 2010, 52(3):207-212
DOI:10.4103/0019-5545.70972  PMID:21180404
  1 3,486 298
LETTERS TO EDITOR
Anti-psychotic drug prescription pattern for schizophrenia: Observation from a general hospital psychiatry unit
JK Trivedi, Mohan Dhyani, VS Yadav, SB Rai
July-September 2010, 52(3):279-279
DOI:10.4103/0019-5545.70996  PMID:21180419
  1 1,535 134
BOOK REVIEW
Psychotherapy in a traditional society: Context, concept, and practice
Ahalya Raguram
July-September 2010, 52(3):292-293
  - 2,726 323
CASE REPORTS
Resolution of symptoms in neuroleptic malignant syndrome
Yvonne D.S. Pereira, Ashish Srivastava, Bramhanand S Cuncoliencar, Nayana Naik
July-September 2010, 52(3):264-266
DOI:10.4103/0019-5545.70988  PMID:21180414
Although neuroleptic malignant syndrome (NMS) manifests consistently with hyperthermia, muscle rigidity, altered mental state, and autonomic instability, heterogeneity exists in the onset, initial manifestations, course, laboratory findings, response to treatment, and pattern of resolution. Comorbid physical conditions tend to confuse the picture. We report a case of NMS with such a presentation.
  - 2,037 118
EDITORIAL
Primary prevention for offspring of parents with mental illness
TS Sathyanarayana Rao, Chittaranjan Andrade
July-September 2010, 52(3):201-202
DOI:10.4103/0019-5545.70970  PMID:21180402
  - 2,163 314
LETTERS TO EDITOR
Cognitive impairment and symptoms of depression among geriatric patients in a tertiary care unit in Sri Lanka
Chaturaka Rodrigo, Sanja Perera, Madura Adhikari, Anoja Rajapakse, Senaka Rajapakse
July-September 2010, 52(3):279-280
DOI:10.4103/0019-5545.71000  PMID:21180418
  - 1,553 162
Why do mentally ill patients seek religious places for treatment?
I Rathinavel, NR Prashanth, P Kasthuri, CN Kumar, H Chandrashekar
July-September 2010, 52(3):280-281
DOI:10.4103/0019-5545.71002  PMID:21180420
  - 1,339 197
Creativity, psychosis and human evolution: The exemplar case of neuregulin 1 gene
Ganesan Venkatasubramanian, Sunil V Kalmady
July-September 2010, 52(3):282-282
DOI:10.4103/0019-5545.71003  PMID:21180422
  - 1,661 111
Psychological support for fathers of artificial insemination donor children
Netto S Ivan, Nilesh Shah
July-September 2010, 52(3):282-283
DOI:10.4103/0019-5545.71005  PMID:21180421
  - 1,189 60
MISCELLANY
Facets of morbid jealousy: With an anecdote from a historical Tamil romance
O Somasundaram
July-September 2010, 52(3):284-288
DOI:10.4103/0019-5545.71007  PMID:21180423
Morbid jealousy is a symptom which occurs in many psychiatric conditions. The complex emotional aspects of jealousy have been discussed by earlier authors. The clinical, cultural, social, and forensic aspects, are touched upon. Morbid jealousy is a favourite topic among novelists and dramatists. "Othello" is a classic example. This topic is covered in one of the famous historical romances of the Tamil author, Kalki.
  - 3,621 156
Anxiety disorders in ancient Indian literature
Hitesh C Sheth, Zindadil Gandhi, GK Vankar
July-September 2010, 52(3):289-291
DOI:10.4103/0019-5545.71009  PMID:21180424
In western literature, the oldest description of symptoms of PTSD, an anxiety group of disorder, is seen in Homer's Iliad written around 720 BC. According to Shay, Achilles was suffering from symptoms of PTSD. However, in the Indian literature it was mentioned around 5000 BC. The description of a PTSD-like syndrome is seen in the Ramayana, although it was not described as PTSD or by any other similar name. Ravana's brother Marrich was having symptoms of PTSD after he was grievously hurt by Lord Rama's arrow and was almost dead. This traumatic event threatened his physical integrity. He developed all the symptoms of PTSD, like hyper-arousal, re-experiencing the events and avoidance. He also gave up his natural work of harassing the monk and got engaged in meditation and austerities. His symptoms lasted for many years till Lord Rama killed him, while he was masquerading as a golden deer to deceive Sita. In another ancient epic Shrimad Bhagavatam, Maharshi Ved Vyasa described the symptoms of Generalized Anxiety Disorder (GAD). The demon King Kansha developed GAD-like symptoms, when Lord Krishna killed all his demons and threatened to kill him. He developed symptoms of GAD, like excessive worry about the attack from his arch foe Krishna, difficulty in concentration and difficulty in falling asleep. Like Marrich, the symptoms of Kansha also lasted until Lord Krishna killed him.
  - 2,769 218
ORIGINAL ARTICLES
Validation of the geriatric depression scale for an elderly Sri Lankan clinic population
M Kulathunga, S Umayal, S Somaratne, S Srikanth, S Kathriarachchi, K.R.D De Silva
July-September 2010, 52(3):254-256
DOI:10.4103/0019-5545.70979  PMID:21180411
Background : Geriatric Depression Scale (GDS) has not been validated for the elderly population in Sri Lanka. Aim : To translate, validate, and examine the effectiveness of GDS and to suggest the optimal cut-off scores for elderly Sri Lankans attending a psychogeriatric clinic. Materials and Methods : The Sinhalese translation of GDS (GDS-S) was administered to people aged 55 years and above, attending a psychogeriatric outpatient clinic. The diagnostic performance of the instrument was compared against the ICD 10 diagnosis of a consultant psychiatrist, which was considered the 'gold standard'. Receiver operating characteristic (ROC) analysis was carried out to compare the diagnostic performance of the GDS-S. Optimal cut-off scores for depression and sensitivity and the specificity of the instrument was determined. Results : A total of 60 subjects formed the final sample (male/female=16/44) of which 30 were depressed, while 30 were age- and sex-matched controls. The optimal cut-off score for GDS-S was 8 for differentiating non-depressed from mildly depressed, while the cut-off score for moderate depression was 10. Sensitivity and specificity of GDS-S was 73.3% for differentiating depressed from non-depressed. Conclusion : GDS is culturally acceptable, easy to use, sensitive, and a valid instrument to diagnose depression and to differentiate mild from moderate depression in an elderly Sri Lankan clinic population.
  - 2,202 174
PG CME
Dose calculation with brief-pulse ECT demystified
Chittaranjan Andrade
July-September 2010, 52(3):276-278
DOI:10.4103/0019-5545.70995  PMID:21180417
  - 2,994 352