Executive functions in depression: a clinical report

Fifty patients of depression and thirty normal subjects were assessed using clinical rating scales and also for the executive functions by Wisconsin Card Sorting Test (WCST). The depressed subjects demonstrated poor performance on WCST suggesting cognitive inflexibility and prefrontal dysfunction. More severe illness was associated with greater impairment in the executive functioning. This pattern of result in conjunction with previous studies supported the idea that depressed patients may have fixed frontally based dysfunction and calls for the use of cognitive assessment and rehabilitation in the patients with depression.

Prevalence of hypertension in psychiatric disorders

OBJECTIVE

To study the prevalence of hypertension in our cases with psychiatric disorders and to study if the prevalence is higher in the cases with psychiatric disorders.

METHODS

Four hundred twenty two cases with various psychiatric disorders attending the Outpatient Department of Psychiatry of our hospital were studied. Detailed clinical evaluation was done in all the cases. Blood pressure was recorded in the sitting position and mean of three readings was taken. Diagnosis and grading of hypertension was done according to the JNC V recommendations. Psychiatric disorders were diagnosed according to DSM IV criteria.

RESULTS

Mean age of the cases was 36.3 years. Prevalence of hypertension in the cases was 7.1%. Prevalence in male and female cases were 7.2% and 7.0%, respectively. Prevalence of hypertension in various age groups was 20-39 years--1.48%, 40-60 years--24.4%, > 60 years--33.3%.

CONCLUSION

The overall prevalence of hypertension in our cases with psychiatric disorders was 7.1% which was not higher than the reported prevalence of hypertension in our general population.

P 300 event related potential in depression

P300 component of the event related potential (ERP) provides one neurophysiological index of cognitive dysfunction in depression. Forty subjects fulfilling DSM-III criteria for depression were compared to 40 age and sex matched normal controls. The P300 was recorded using the auditory odd-ball paradigm. Depressives had a significantly prolonged P300 latency and reduced P300 amplitude as compared to the controls. The P300 latency showed a significant positive correlation with age of the patient and severity of depression while P300 amplitude showed a significant negative correlation with age. The clinical subcategory of depression, duration of illness and sex did not show any relationship with P300 abnormality. Twelve out of 40 depressives (30%) had an abnormal P300. The mean Hamilton Rating Scale for Depression (HRSD) score was significantly high in those with an abnormal P300.

P300 event related potential in normal healthy controls of different age groups

P300 event related potential was recorded in 115 healthy controls with a mean age of35.9±14.81 years and a male : female ratio of 72 : 43. There was significant difference in the P300 latency in < 40 years as compared to ≥ 40 years group (p< 0.001). There was no significant difference between males and females. There was a strong positive correlation between age and P300 latency (p< 0.001). The regression equation for P300 latency was Y=287.9+1.492x with an SEE of 20.2 (where Y is the P300 latency in ms, x is the age in years, SEE is the standard error of estimate). There was a negative correlation between age and P300 amplitude which was significant in ≥ 40 years age group while in > 40 years age group it was not significant.

Serum lipid profile in suicide attempters

Practical difficulties associated with assessment of central parameters necessitates the development of peripheral markers of suicidal risk. Recent research suggest that serum lipid profile may be a useful indicator of suicidal behaviour. Serum lipid profiles of forty suicide attempters were compared with forty age, sex and BMI matched controls.Total serum cholesterol, serum Triglyceride, LDL levels and HDL levels were found to be lower in suicide attempters but were not statistically significant. Statistically significant negative con-elation was seen between risk-rescue score and above mentioned parameters. No statitically significant difference was observed when various diagnostic break-up groups of patients were compared.

Serum lipids : new biological markers in depression ?

Several studies suggest that a low cholesterol concentration is associated with depression. The authors sought to determine whether an association exists between serum lipid concentrations and depression. 28 drug-naive patients of major depression diagnosed according to DSMlll- R criteria were included in the study and severity of depression was measured on Hamilton Rating Scale for Depression. Suicidal intent was assessed on Suicidal Intent Questionnaire. 28 normal healthy controls were selected and matched for age, sex and body-mass index with the depressives. Serum lipid estimations were done in each subject after 12 hours overnight fasting. The main finding of the study is that total serum cholesterol, serum triglycerides and serum LDL cholesterol are decreased while serum HDL cholesterol is increased in depression and these changes were more marked in depressed subjects with definite suicidal intent. On regression analysis, total serum cholesterol was the most important predictive variable of the severity of depression.

Active platelet 5-ht uptake in depressives treated with impramine and ect

Several studies have reported decreased platelet 5-HT uptake in patients of major depression. The present study was undertaken with the aim to study the active platelet 5-HT uptake in depressed patients and effect of treatment with imipramine/ECT on platelet 5-HT uptake in these patients. 30 patients of major depression and equal number of age and sex-matched controls were included in the study. The depressives received imipramine (N=15) or ECT (N=15). Pretreatment active platelet 5-HT uptake was lower in depressives. Treatment with imipramine resulted in significant decrease in 5-HT uptake while with ECT there was significant increase. The serotonergic mechanisms are discussed.

Psychiatric sequelae of amputation : ii long term effects

Psychiatric sequelae present after 6 months to 2 years following amputation were studied in a group of 25 subjects. The subjects were screened on SCID, HRSD and HARS. The most common diagnoses were depressive disorder NOS (20.6%) and major depressive disorder (10.3%). Patients having right sided amputation were more psychiatrically ill than those with loss of a left limb. Phantom limb was seen in about two-thirds of the total sample-more in the sick group (about 88%) than in the non-sick group (about 55%). Pain in the phantom limb was seen more in the sick group, but telescopy and movement were more frequently complained of by subjects of the non-sick group.

Psychiatric sequelae of amputation : I immediate effects

Twenty-five subjects, who had undergone amputation within last 6 weeks, were studied for psychiatric complications, including phantom limb phenomena. The patients were interviewed on SCID, HRSD and HARS. Out of a total of 25 subjects, 8 (34.6%) developed psychiatric disorders - PTSD and major depression. The whole sample was thus divided into 2 groups-sick and nonsick. Phantom limb was seen in 88% subjects. No significant difference was present between the two groups with regard to presence of phantom, its associated phenomena of pain, telescopy and movement. A statistically significant difference was seen in psychiatric sickness in relation to upper and lower limb.

Ect and platelet 5ht uptake in major depression

Several studies have reported decreased platelet 5-HT uptake in patients of major depression. The mechanism of antidepressant action of ECT is not clear. The present work was undertaken with the aim to study the active platelet 5-HT uptake and the effect of ECT on it in patients of major depression. 15 patients of major depression (DSM-lll-R) and equal number of age and sex-matched controls were included in the study. Active platelet 5-HT uptake was determined before ECT, after a course of ECT and 7 days after last ECT. Platelet 5-HT uptake was. significantly lower in der essives than normal controls. After ECT treatment there was significant increase in 5-HT uptake which came down to pretreatment level after 1 week of last ECT. The effect of ECT on serotonergic system is discussed.

Psychosocial aspects of amputation

Twenty-five subjects were studied who had undergone amputation 6 months to 2 years prior to the time of assessment. The sample was divided into sick (those having psychiatric illness) and non-sick (those without any psychiatric illness) groups, and then compared for various life events following the amputation. It was seen that those who were labelled as psychiatrically sick had more work impairment, change in job, socioeconomic difficulties and social avoidance. The latter two factors were also significantly more in right upper limb amputees than the left upper limb amputees; no such difference existed between the upper and lower limb amputees.

Treatment of acute and transient psychotic disorders with low and high doses of oral haloperidol

The apparent rationale for the popular use of high doses of neuroleptics in psychotic patients is to increase the degree and speed of therapeutic response .However, several recent reports have questioned these claims. The present study was undertaken with the aim to compare the efficacy of high and low oral doses of haloperidol in the treatment of acute and transient psychotic disorders. The sample comprised of forty patients of both sexes diagnosed as acute and transient psychotic disorder who were randomly assigned to high dose (20 mg/day) and low dose (5 mg /day) haloperidol groups with equal number of subjects (n=20) in both groups. Weekly assessment was done on Brief Psychiatric Rating Scale and Haloperidol Side-effects Check List (day 7, 14, 21, 28, 35 & 42). Both groups showed significant improvement in BPRS from baseline scores on all assessments. Comparison of the improvement rate in both study groups revealed no significant difference.

Csf 5 - hiaa in violent and non-violent suicide attempters

Many studies have reported involvement of monoamine neurotransmission in suicide through measurement of serotonin and its main metabolite, 5-HIAA, in brain of suicide victims and in CSF of suicide attempters. 23 non-depressed non-psychotic suicide attempters and equal number of controls were selected, and all the subjects were screened on Cornell Medical Index. Suicide attempters were assessed on Risk-Rescue Rating Scale and were divided into non-violent suicide attempters (N= 12) and violent suicide attempters (N= II). CSF of all subjects was collected by lumbar puncture and CSF 5-HIAA was measured by high performance liquid chromatography with electro-chemical detector. Risk-rescue rating score was significantly higher in violent suicide attempters as compared to non-violent suicide attempters. Mean CSF- 5- HIAA was significantly lower in suicide attempters as compared to normal controls. Mean CSF 5-HIAA was significantly lower in violent suicide attempters as compared to non-violent suicide attempters.