1
|
Mamtani H, Jain K, Reddy P, Arasappa R, Ganjekar S, Thippeswamy H, Bhat M, Netravathi M, Desai G. The co-occurrence of multiple sclerosis and bipolar disorder: A case series on clinical and neuroimaging correlates. Asian J Psychiatr 2024; 96:104041. [PMID: 38615578 DOI: 10.1016/j.ajp.2024.104041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/12/2024] [Accepted: 03/30/2024] [Indexed: 04/16/2024]
Abstract
There is a dearth of studies on neuroimaging correlates of Bipolar Disorder (BD) in Multiple Sclerosis (MS). We describe the clinical profile and neuroimaging findings of four cases of MS with BD. Among them, two patients had multiple mood episodes preceding the neurological symptoms, one had concurrent manic and neurological symptoms, and one had multiple depressive episodes and an isolated steroid-induced manic episode. Frontal and temporal lobes, and Periventricular White Matter were involved in all four cases, and hence may be considered biological substrates of BD in MS. Larger studies are needed to validate the utility of these findings.
Collapse
Affiliation(s)
- Harkishan Mamtani
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Kshiteeja Jain
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Preethi Reddy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Sundarnag Ganjekar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Maya Bhat
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - M Netravathi
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India.
| |
Collapse
|
2
|
Mailankody P, Kamble N, Bhattacharya A, Shubha Bhat GS, Arumugam T, Thennarasu K, Arasappa R, Varambally S, Yadav R, Pal PK. Yoga as an Add-on Therapy in Parkinson's Disease: A Single Group Open-label Trial. Can J Neurol Sci 2024:1-8. [PMID: 38525880 DOI: 10.1017/cjn.2024.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
OBJECTIVE We aimed to evaluate the effect of yoga on motor and non-motor symptoms and cortical excitability in patients with Parkinson's disease (PD). METHODS We prospectively evaluated 17 patients with PD at baseline, after one month of conventional care, and after one month of supervised yoga sessions. The motor and non-motor symptoms were evaluated using the Unified Parkinson's disease Rating Scale (motor part III), Hoehn and Yahr stage, Montreal Cognitive Assessment, Hamilton depression rating scale, Hamilton anxiety rating scale, non-motor symptoms questionnaire and World Health Organization quality of life questionnaire. Transcranial magnetic stimulation was used to record resting motor threshold, central motor conduction time, ipsilateral silent period (iSP), contralateral silent period (cSP), short interval intracortical inhibition (SICI), and intracortical facilitation. RESULTS The mean age of the patients was 55.5 ± 10.8 years, with a mean duration of illness of 4.0 ± 2.5 years. The postural stability of the patients significantly improved following yoga (0.59 ± 0.5 to 0.18 ± 0.4, p = 0.039). There was a significant reduction in the cSP from baseline (138.07 ± 27.5 ms) to 4 weeks of yoga therapy (116.94 ± 18.2 ms, p = 0.004). In addition, a significant reduction in SICI was observed after four weeks of yoga therapy (0.22 ± 0.10) to (0.46 ± 0.23), p = 0.004). CONCLUSION Yoga intervention can significantly improve postural stability in patients with PD. A significant reduction of cSP and SICI suggests a reduction in GABAergic neurotransmission following yoga therapy that may underlie the improvement observed in postural stability. CLINICALTRIALSGOV IDENTIFIER CTRI/2019/02/017564.
Collapse
Affiliation(s)
- Pooja Mailankody
- Department of Neurology, National Institute of Mental Health & Neuro Sciences, Bangalore, Karnataka, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neuro Sciences, Bangalore, Karnataka, India
| | - Amitabh Bhattacharya
- Department of Neurology, National Institute of Mental Health & Neuro Sciences, Bangalore, Karnataka, India
| | - G S Shubha Bhat
- Department of Neurology, National Institute of Mental Health & Neuro Sciences, Bangalore, Karnataka, India
| | - Thamodharan Arumugam
- Department of Neurology, National Institute of Mental Health & Neuro Sciences, Bangalore, Karnataka, India
| | - K Thennarasu
- Department of Biostatistics, National Institute of Mental Health & Neuro Sciences, Bangalore, Karnataka, India
| | - Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Bangalore, Karnataka, India
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Bangalore, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health & Neuro Sciences, Bangalore, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neuro Sciences, Bangalore, Karnataka, India
| |
Collapse
|
3
|
Mamtani H, Utagi S, Chaurasia KK, Reddy PV, Arasappa R, Prasad C, Srinivas D, Rao MB, Thippeswamy H. Bell's mania as a clinical presentation in a neurosurgical setting from a tertiary care neuropsychiatric hospital in India. Indian J Psychiatry 2024; 66:208-212. [PMID: 38523764 PMCID: PMC10956591 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_417_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/12/2023] [Accepted: 01/15/2024] [Indexed: 03/26/2024] Open
Abstract
Bell's mania is the co-occurrence of delirium and mania. We present two cases of Bell's mania in a neurosurgical setting. The first case is of a 52-year-old male who presented with holocranial headache, disorientation, and manic symptoms for five months. He was found to have suprasellar craniopharyngioma. He significantly improved with olanzapine, but re-emergence of mood symptoms was noted after surgery. The second case is of a 42-year-old male who presented with a 15-day history of seizures and disorientation. He was found to have a dural arteriovenous fistula. He developed Bell's mania in the post-procedural period, which improved with olanzapine. Compression of the hypothalamo-pituitary stalk in the first case and vascular and inflammatory changes in the second case could have led to Bell's mania. Atypical age of onset and presence of neurological symptoms in patients presenting with psychiatric symptoms should raise the suspicion of an underlying organicity. Atypical anti-psychotics can be a useful management strategy for Bell's mania.
Collapse
Affiliation(s)
- Harkishan Mamtani
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Shridhar Utagi
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Kavish K. Chaurasia
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Preethi Veerappa Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Chandrajit Prasad
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Malla Bhaskara Rao
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| |
Collapse
|
4
|
Talukdar PM, Reddy PV, Bhargav PH, Subbanna M, Karmani S, Arasappa R, Subramanian GV, Kesavan M, Debnath M. Long-term Add-on Yoga Therapy Modulates Oxidative Stress Pathway and Offers Clinical Benefits in Major Depressive Disorder: A Randomized Controlled Trial. Int J Yoga 2023; 16:180-184. [PMID: 38463645 PMCID: PMC10919410 DOI: 10.4103/ijoy.ijoy_174_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 03/12/2024] Open
Abstract
Background Yoga therapy (YT) as an adjunct treatment has reportedly been demonstrated to offer clinical benefits in major depressive disorder (MDD). Although a few biological pathways are suggested to mediate the effects of yoga, the precise mechanistic basis remains unknown. Oxidative stress pathway activation has consistently been linked to the pathobiology of MDD. Whether YT has a modulatory effect on the oxidative stress pathway in MDD is not adequately understood. Aim and Objectives In this study, we examined the impact of a course (3 months) of yoga as an add on therapy on the markers of the oxidative stress pathway in MDD patients. Methods Thirty-three MDD patients were randomized to the YT (n = 16) and waitlist control (WC) (n = 17) groups. Colorimetric estimation of the plasma malondialdehyde (MDA) and total antioxidant (AO) levels was performed in all the study participants using commercially available kits at the baseline and after 3 months. Results A significant reduction of plasma MDA levels was observed in MDD patients of YT group (P = 0.05) after 3 months of YT. Notably, the plasma MDA levels also decreased in MDD patients of WC group (P = 0.015) after the trial period. In addition, levels of total AO showed a trend toward significance only in MDD patients after 3 months of YT (P = 0.07). Conclusion: The current study suggests that the benefits of YT might be mediated through its modulatory role on the oxidative stress pathway in MDD.
Collapse
Affiliation(s)
- Pinku Mani Talukdar
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Preethi V. Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Praerna Hemant Bhargav
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Manjula Subbanna
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sneha Karmani
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ganesan Venkata Subramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Muralidharan Kesavan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Monojit Debnath
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| |
Collapse
|
5
|
Reddy PV, Talukdar PM, Subbanna M, Bhargav PH, Arasappa R, Venkatasubramanian G, Muralidharan K, Debnath M. Multiple Complement Pathway-related Proteins Might Regulate Immunopathogenesis of Major Depressive Disorder. Clin Psychopharmacol Neurosci 2023; 21:313-319. [PMID: 37119224 PMCID: PMC10157013 DOI: 10.9758/cpn.2023.21.2.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/16/2022] [Accepted: 04/30/2022] [Indexed: 05/01/2023]
Abstract
Objective Exacerbated inflammatory pathway has emerged as a predominant etiological construct of major depressive disorder (MDD). Innate immune molecules like complement proteins induce inflammatory responses and also regulate key neurobiological processes. However, there is a dearth of literature on the impact of critical complement proteins in MDD. Herein, plasma profiling of seven complement proteins was carried out to obtain a better insight into the role of the complement pathway in MDD. Methods Plasma levels of C1q, C3, C3b/iC3b, C4, Factor B, Factor H, and properdin were assayed in 22 patients with MDD and 27 healthy controls by multiplex suspension assay. The patients with MDD were diagnosed as per DSM IV-TR. Hamilton Depression Rating Scale (HAM-D), Montgomery Depression Rating Scale and Clinical Global Improvement were used for clinical assessments of the patients. The plasma levels of these complement proteins were also correlated with various clinical scores and phenotypes of MDD. Results The patients with MDD and healthy controls did not differ in terms of age and gender (p > 0.1). The patients with MDD had a mean duration of illness of around 3 years, with average number of depressive episodes being 6 and the mean HAM-D score was 19. Of the seven complement components, the plasma levels of C1q, Factor B, and Factor H (p ≤ 0.05) were significantly elevated in MDD patients compared to healthy controls. However, the plasma levels of these complement proteins were not found to correlate with the clinical profile of MDD patients. Conclusion Both Factor B and Factor H are crucial in the induction and regulation of the alternative pathway of complement activation. The alternative pathway also plays a critical role in inflammation. These findings suggest an important role of the alternative complement pathway in immuno-inflammation in MDD.
Collapse
Affiliation(s)
- Preethi V Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Pinku Mani Talukdar
- Department of Human Genetics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Manjula Subbanna
- Department of Human Genetics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Praerna H Bhargav
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Kesavan Muralidharan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Monojit Debnath
- Department of Human Genetics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| |
Collapse
|
6
|
Arasappa R, Chithra NK, Kulkarni KR, Muliyala KP, Murthy P, Kesavan M. Gender differences in the young-onset persistent delusional disorder. Asian J Psychiatr 2023; 86:103653. [PMID: 37270876 DOI: 10.1016/j.ajp.2023.103653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023]
Abstract
We conducted a retrospective chart review to examine the gender differences in young onset Persistent Delusional Disorder (PDD) subjects (N = 236) with onset of illness before the age of 30 years. Gender differences in marital and employment status were significant (p-0.001). Delusion of infidelity and erotomania were more common in females, while males had more body dysmorphic and persecutory delusions (X2-20.45, p-0.009). Males had more substance dependence (X2-21.31, p < 0.001), as well as a family history of substance abuse and PDD (X2-18.5, p < 0.01). To conclude, gender differences in PDD comprised some psychopathology, co-morbidity, and family history among those with young onset PDD.
Collapse
Affiliation(s)
- Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India.
| | - Nellai K Chithra
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Krishna Prasad Muliyala
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Muralidharan Kesavan
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| |
Collapse
|
7
|
Arasappa R, Rangaiah URM, Nanjundaswamy MH, Ganjekar S, Varambally S, Chandra PS. Feasibility and Acceptability of a joint mother infant yoga intervention in mothers admitted to an inpatient mother baby unit. Asian J Psychiatr 2023; 82:103461. [PMID: 36682156 DOI: 10.1016/j.ajp.2023.103461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/24/2022] [Accepted: 01/09/2023] [Indexed: 01/11/2023]
Abstract
Mothers with severe mental illness in the postpartum may have problems in bonding with their infants and there is a need to develop effective and acceptable interventions. Yoga has been shown to improve social cognition as well as increase oxytocin levels and maybe of value. This paper describes the feasibility and acceptability of a mother-infant yoga intervention in 14 mothers with severe mental illness admitted to a Mother Baby Unit in India. Mothers found the module acceptable and completion rates for mother-infant dyads were adequate.
Collapse
Affiliation(s)
- Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India.
| | - Usha Rani M Rangaiah
- Department of Integrative Medicine, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Madhuri H Nanjundaswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Sundarnag Ganjekar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India; Department of Integrative Medicine, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| |
Collapse
|
8
|
Bhargav H, Eiman N, Jasti N, More P, Kumar V, Holla B, Arasappa R, Rao NP, Varambally S, Gangadhar B, Keshavan MS. Composition of yoga-philosophy based mental traits ( Gunas) in major psychiatric disorders: A trans-diagnostic approach. Front Psychol 2023; 14:1075060. [PMID: 36818072 PMCID: PMC9930472 DOI: 10.3389/fpsyg.2023.1075060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/04/2023] [Indexed: 02/04/2023] Open
Abstract
Yoga philosophy includes the theory of Tri-guna (three mental traits): sattva (signifies a tendency to 'goodness'), rajas (tendency towards 'activity'), and tamas (tendency towards "inertia"). This cross-sectional study aimed to understand the differences in the expression of gunas in patients suffering from major psychiatric disorders (n = 113, 40 females) and age-gender-education-matched healthy controls (HCs; n = 113, 40 females). Patients were diagnosed by a psychiatrist using DSM 5 criteria and suffered from the following disorders: depression (n = 30), schizophrenia (SCZ; n = 28), obsessive-compulsive disorder (OCD; n = 23), anxiety (n = 16), and bipolar affective disorder (BPAD; n = 16). Tri-gunas were assessed using a validated tool (Vedic Personality Inventory) and symptoms were assessed using standard scales as per the diagnosis. Multi-variate analysis of variance (MANOVA) was used to assess the differences in guna scores between HCs and patients, and between patients with different diagnoses. A two-tailed Pearson correlation was performed between the gunas and psychometric scales. Results revealed that HCs had significantly higher sattva traits as compared to patients (except those with OCD). Each psychiatric diagnosis also showed a specific guna configuration: (1) Anxiety disorders and OCD: High sattva-rajas, low tamas; (2) Depression: High sattva-tamas, low rajas; (3) Psychotic disorders (SCZ/BPAD): High tamo-rajas, low sattva. Significant positive correlations were observed between rajas traits and anxiety/OC/positive psychotic symptoms, negative psychotic symptoms and tamas traits, and sattva traits and OC symptoms. This finding has clinical implications, both to develop ways of predicting outcomes of psychiatric disorders, as well as to develop psycho-therapeutic and lifestyle interventions targeting the gunas.
Collapse
Affiliation(s)
- Hemant Bhargav
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India,*Correspondence: Hemant Bhargav, ✉
| | - Najla Eiman
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Nishitha Jasti
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Pooja More
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Vinod Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Bharath Holla
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Rashmi Arasappa
- Massachusetts Mental Health Center, Boston, MA, United States
| | - Naren P. Rao
- Massachusetts Mental Health Center, Boston, MA, United States
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - B.N. Gangadhar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Matcheri S. Keshavan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
9
|
Banerjee D, Arasappa R, Chandra PS, Desai G. "It seemed like my fault for wanting to become a mother …"-Experiences and perceptions related to motherhood in women with severe mental illness. Asia Pac Psychiatry 2022; 14:e12519. [PMID: 35899683 DOI: 10.1111/appy.12519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 07/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Women with mental illness experience unique challenges during their motherhood. However, little is known about their own perceptions and unmet needs in the process of childbearing. A qualitative study design with a social constructivist paradigm was used to explore lived experiences of mothers with severe mental illness (SMI) during the childbearing period. METHODS Semi-structured in-depth interviews were conducted with 30 mothers recruited through purposive sampling. This was followed by inductive thematic analysis. Rigor was established through triangulation and respondent validation. This paper focuses on the perceptions during the pre-conception and pregnancy period. RESULTS Emergent categories (themes) were thoughts/feelings about childbearing (ambivalence about being a mother/having a baby, fantasies about childbearing/rearing, guilt about pregnancy), the impact of mental illness (stigma, effect of symptoms on their self-care including healthcare, concerns about effect of medications on fetus), unmet needs (lack of emotional support, unanswered doubts about effects of illness on pregnancy, child and motherhood, wanting to be considered as "potential mothers"), and caregivers' reactions (discrimination, anger/abuse, selective support). The centrality of motherhood and balancing the "dual role" of a patient and mother were the overarching categories after analysis. CONCLUSION Mothers with SMI prize motherhood but navigate through it with various adverse experiences. The results of this study, grounded in their voices, provide critical insights for service and policy provisions in perinatal psychiatry.
Collapse
Affiliation(s)
- Debanjan Banerjee
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| |
Collapse
|
10
|
Arora S, Jolly AJ, Suhas S, Arasappa R, Kamble N, Pal PK, Varambally S. Subacute Sclerosing Panencephalitis Masquerading as Schizophrenia. Prim Care Companion CNS Disord 2022; 24. [DOI: 10.4088/pcc.21cr02997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
11
|
Chithra NK, Reddy PV, Tansa KA, Arasappa R, Raj A, Jangam K, Kesavan M. Intimate partner violence in women with psychotic disorders. Asian J Psychiatr 2022; 67:102942. [PMID: 34864339 DOI: 10.1016/j.ajp.2021.102942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/18/2021] [Indexed: 11/02/2022]
Affiliation(s)
- Nellai K Chithra
- National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Preethi V Reddy
- National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - K A Tansa
- National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Rashmi Arasappa
- National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Aravind Raj
- National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Kavita Jangam
- National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | | |
Collapse
|
12
|
Subbanna M, Talukdar PM, Abdul F, Debnath M, Reddy PV, Arasappa R, Venkatasubramanian G, Muralidharan K, Gangadhar BN, Bhargav PH, Karmani S. Long-term add-on Yoga therapy offers clinical benefits in major depressive disorder by modulating the complement pathway: A randomized controlled trial. Asian J Psychiatr 2021; 66:102876. [PMID: 34649098 DOI: 10.1016/j.ajp.2021.102876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Manjula Subbanna
- Department of Human Genetics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Pinku Mani Talukdar
- Department of Human Genetics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Fazal Abdul
- Department of Human Genetics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Monojit Debnath
- Department of Human Genetics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
| | - Preethi V Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Kesavan Muralidharan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Bangalore N Gangadhar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Praerna H Bhargav
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Sneha Karmani
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| |
Collapse
|
13
|
Arasappa R, Bhargav H, Ramachandra K, Varambally S, Gangadhar BN. Perspective of patients referred to Yoga center in a tertiary neuropsychiatric hospital: A cross-sectional retrospective study. Indian J Psychiatry 2021; 63:543-548. [PMID: 35136250 PMCID: PMC8793704 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_1164_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 05/25/2021] [Accepted: 09/29/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Yoga has been extensively used as an alternative or complementary therapy in psychiatric disorders depending on the type and severity of the disorders. However, data related to perspective on yoga services and the benefits and adverse effects attributed to yoga by patients with major psychiatric disorders is lacking. AIM The aim of the study was to assess feedback of the patients who attended yoga sessions at a Yoga center in a tertiary neuropsychiatric hospital. MATERIALS AND METHODS This was a cross-sectional retrospective study using a specific questionnaire to get feedback from patients referred to the NIMHANS Integrated Center for Yoga, at the end of their yoga training. RESULTS Two hundred and one patients' data were included in this retrospective study. Most of the patients were referred by the doctors. The yoga module for schizophrenia was most commonly utilized, followed by depression. On an average, patients attended 13 sessions. Most of them practiced yoga for 1-2 weeks and had missed less than 2 sessions. The great majority of the patients reported that practicing yoga helped them. Spearman correlation analysis revealed positive associations between improvement attributed to yoga and variables affecting quality of yoga services at the center, including the quality of yoga sessions attended. Overall health and sleep improvement also positively correlated with improvement attributed to yoga. A minority of patients reported adverse effects, although these did not lead to discontinuation. CONCLUSION In this retrospective study of patients referred to a Yoga center in a tertiary psychiatric facility, the majority of patients with major mental disorders were able to practice yoga under supervision and reported significant improvement in symptoms with minimal adverse effects.
Collapse
Affiliation(s)
- Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Hemant Bhargav
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Kavitha Ramachandra
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.,Department of Integrative Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Bangalore N Gangadhar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| |
Collapse
|
14
|
Jha M, Dumbala S, Gulati K, Bhargav H, Arasappa R, Varambally S, Gangadhar BN, Desai G. Yoga Module for Somatoform Pain Disorders: Development, Content Validation, and Feasibility Testing. Int J Yoga 2021; 14:206-212. [PMID: 35017862 PMCID: PMC8691440 DOI: 10.4103/ijoy.ijoy_125_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 05/04/2021] [Accepted: 06/16/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Yoga practices have been found to be useful in chronic pain conditions but studies focussing specifically on somatoform pain disorders (SPDs) are limited. AIMS Current study aims to develop and test the feasibility of a yoga program for patients with SPDs. MATERIALS AND METHODOLOGY Athorough search of traditional and contemporary literature was performed with the objective of formulating a yoga program for reducing chronic non-specific pain and associated psychological distress. Content validity of the program was then determined by taking the opinion of 18 yoga experts (who had >5 years of experience in treating mental health disorders) using content validation ratio (CVR) through Lawshe's formula. The feasibility of the module was tested on 10 subjects diagnosed with SPDs as per the International Classification of Diseases (ICD) -10 criteria using standard scales. RESULTS In the finalized module, 70.83% (34 out of 48 items) of the practices were retained along with the modifications as suggested by the experts. Two practices were not found to be feasible (Trikonasana and Shalabhasana) and hence were removed from the final module. A significant reduction in pain severity was observed in the subjects after practising the yoga module for 2 weeks. The content validity index for the whole module (average of all CVRs) was 0.55. CONCLUSIONS Ayoga module was developed for SPD. The content validity of the module was found to be good. The module was found safe and potentially useful for reducing pain severity in patients with SPD. Future studies should test the efficacy of the developed program through a randomized controlled clinical trial.
Collapse
Affiliation(s)
- Monika Jha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sowjanya Dumbala
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Kankan Gulati
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Hemant Bhargav
- Department of Integrative Medicine, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
- Department of Integrative Medicine, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - BN Gangadhar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
- Department of Integrative Medicine, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| |
Collapse
|
15
|
Kumar V, Bhide SR, Arasappa R, Varambally S, Gangadhar BN. ‘Soother of mind’ – meditation in psychiatric disorders: a narrative review. BJPsych advances 2021. [DOI: 10.1192/bja.2021.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYMeditation, a component of ashtanga yoga, is an act of inward contemplation in which the mind fluctuates between a state of attention to a stimulus and complete absorption in it. Some forms of meditation have been found to be useful for people with psychiatric conditions such as anxiety, depression and substance use disorder. Evidence for usefulness of meditation for people with psychotic disorders is mixed, with reported improvements in negative symptoms but the emergence/precipitation of psychotic symptoms. This article narrates the benefits of meditation in psychiatric disorders, understanding meditation from the yoga perspective, biological aspects of meditation and practical tips for the practice of meditation. We also explain possible ways of modifying meditative practices to make them safe and useful for the patient population and useful overall as a society-level intervention.
Collapse
|
16
|
Bhat SGS, Arasappa R, Jagannathan A, Varambally S. Yoga therapy for Obsessive Compulsive Disorder (OCD): A case series from India. Asian J Psychiatr 2021; 62:102739. [PMID: 34243060 DOI: 10.1016/j.ajp.2021.102739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/09/2021] [Accepted: 06/25/2021] [Indexed: 11/24/2022]
Abstract
Yoga is an ancient science which has been found to be helpful in the management of several psychiatric disorders including Obsessive Compulsive Disorder (OCD). Yoga as add-on treatment in OCD may help address issues like partial response and adverse effects of medications. However, research in this area is sparse, which led us to explore it through this case series. In this case series we have described the benefits of 1 month of yoga as add-on treatment in patients with OCD. All patients were on stable doses of medications prior to and during yoga practice. Pre-post assessments for the core symptoms of obsession/compulsions as well as depressive and anxiety symptoms were done. The assessments showed significant improvement in Y-BOCS and HAM-D scores after 1 month of yoga. Yoga therapy could be an effective add-on therapy for the treatment of OCD.
Collapse
Affiliation(s)
- Shubha G S Bhat
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India.
| | - Aarti Jagannathan
- Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| |
Collapse
|
17
|
Banerjee D, Arasappa R, Chandra PS, Desai G. "Hear me out": experiences of women with severe mental illness with their healthcare providers in relation to motherhood. Asian J Psychiatr 2021; 55:102505. [PMID: 33310343 DOI: 10.1016/j.ajp.2020.102505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/06/2020] [Accepted: 11/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most women with severe mental illness (SMI) are mothers, however little is known about their own experiences of how the health care providers offer support in handling motherhood. This study attempted to assess the barriers, expectations and facilitators in seeking help from mental health care providers in matters of pregnancy and motherhood using a qualitative methodology. METHODS The study used a qualitative design with social constructivist paradigm to obtain data from 30 mothers with SMI who had children less than five years of age. One-to-one in-depth semi-structured interviews were conducted and inductive thematic analysis was used to explore transcripts using Charmaz's grounded theory. RESULTS Main barriers in seeking help from health care providers were perceived stigma, treatment side-effects, misinterpretations of information and health providers not having enough time. On the other hand self-advocacy, early engagement with the health care system, being psychoeducated and involvement of the family with service providers were the facilitating factors. The prime expectations of the mothers were early and direct communication and basic guidance regarding child health and parenting issues. CONCLUSION Women who are mothers and also users of mental health services face special challenges in managing their illness and motherhood. Hearing their voices is essential for service provision and ensuring adequate mental health and handling motherhood.
Collapse
Affiliation(s)
- Debanjan Banerjee
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| |
Collapse
|
18
|
Dumbala S, Bhargav H, Satyanarayana V, Arasappa R, Varambally S, Desai G, Bangalore GN. Effect of Yoga on Psychological Distress among Women Receiving Treatment for Infertility. Int J Yoga 2020; 13:115-119. [PMID: 32669765 PMCID: PMC7336944 DOI: 10.4103/ijoy.ijoy_34_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/20/2019] [Accepted: 09/11/2019] [Indexed: 12/18/2022] Open
Abstract
Background Infertility among women has been associated with significant psychological distress, anxiety, and depression. yoga therapy has been found to be useful in the management of anxiety, depression and psychological distress. Aim To review studies on the effectiveness of yoga in reducing psychological distress and improving clinical outcomes among women receiving treatment for infertility. Methodology PubMed, ScienceDirect, and Google Scholar databases were searched for studies using the following inclusion criteria: studies published in English, those published between 2000 and 2018, published in peer-reviewed journals, and those with Yoga as an intervention. Review articles, studies without any yoga interventions for infertility, and male infertility were excluded. The keywords included for the literature search were: Yoga, Mindfulness, Relaxation technique, Stress, Distress, Anxiety, Infertility, In Vitro Fertilization (IVF), and Assisted Reproductive Technology (ART). Results Three studies satisfied the selection criteria. Two studies involved Hatha yoga intervention and one study used structured yoga program. The variables assessed in these studies were: (1) anxiety, (2) depression, (3) emotional distress, and (4) fertility-related quality of life. All the studies reported an improvement in the anxiety scores after yoga intervention. Conclusion Yoga therapy may be potentially useful in improving anxiety scores among women suffering from infertility. More studies are needed in this area to establish role of yoga as an adjuvant during the treatment of infertility.
Collapse
Affiliation(s)
| | - Hemant Bhargav
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | | | - Rashmi Arasappa
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | | | - Geetha Desai
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | | |
Collapse
|
19
|
Rao NP, Deshpande G, Gangadhar KB, Arasappa R, Varambally S, Venkatasubramanian G, Ganagadhar BN. Directional brain networks underlying OM chanting. Asian J Psychiatr 2018; 37:20-25. [PMID: 30099280 DOI: 10.1016/j.ajp.2018.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 08/01/2018] [Accepted: 08/01/2018] [Indexed: 02/05/2023]
Abstract
OM chanting is an ancient technique of Indian meditation. OM chanting is associated with an experience of relaxation, changes in autonomic balance and deactivation of limbic brain regions. While functional localization is important, how brain regions interact with each other has been shown to underlie various brain functions. Therefore, in this study, we tested the hypothesis that there is reduced communication between deactivated regions during OM chanting. In order to do so, we employed multivariate autoregressive model (MVAR) based Granger causality to obtain directional connectivity between deactivated regions. fMRI scans of 12 right handed healthy volunteers (9 Men) from a previously published study was used in which participants performed OM chanting and a control condition in a block design. We found that outputs from insula, anterior cingulate and orbitofrontal cortices were significantly reduced in OM condition. Of interest is the reduction of outputs from these regions to limbic area amygdala. Modulation of brain regions involved in emotion processing and implicated in major depressive disorder (MDD) raises a potential possibility of OM chanting in the treatment of MDD.
Collapse
Affiliation(s)
- Naren P Rao
- National Institute of Mental Health and Neurosciences, Bangalore, India.
| | - Gopikrishna Deshpande
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, USA; Department of Psychology, Auburn University, Auburn, AL, USA; Alabama Advanced Imaging Consortium, Auburn University and University of Alabama Birmingham, AL, USA
| | | | - Rashmi Arasappa
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | | | | |
Collapse
|
20
|
Kulkarni K, Arasappa R, Prasad M K, Zutshi A, Chand PK, Muralidharan K, Murthy P. The impact of depressive symptoms on the clinical presentation of Persistent Delusional Disorder. Asian J Psychiatr 2018; 32:123-125. [PMID: 29248867 DOI: 10.1016/j.ajp.2017.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 11/15/2017] [Accepted: 12/03/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Our aim was to investigate the influence of depressive symptoms on the clinical presentation of Persistent Delusional Disorder (PDD). METHODS We have previously conducted a retrospective review of patients diagnosed with PDD (n = 455). We divided this sample into two groups according to the presence or absence of co-morbid depressive symptoms - a subsample of PDD with depressive co-morbidity (PDD + D; n = 187) and a subsample of PDD without depressive co-morbidity (PDD only; n = 268). RESULTS PDD + D group had a significantly younger age at onset of PDD. The PDD + D group received significantly more antidepressants but had similar response and adherence rates. CONCLUSIONS The presence of depressive symptoms in 41% of the study population did not appear to influence the clinical presentation or response to treatment.
Collapse
Affiliation(s)
- Karishma Kulkarni
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore, 560029, Karnataka, India.
| | - Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore, 560029, Karnataka, India
| | - Krishna Prasad M
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore, 560029, Karnataka, India
| | - Amit Zutshi
- Epworth Hospital, Camberwell, Victoria, 3124, Australia; Department of Psychiatry, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Australia
| | - Prabhat K Chand
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore, 560029, Karnataka, India
| | - Kesavan Muralidharan
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore, 560029, Karnataka, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore, 560029, Karnataka, India
| |
Collapse
|
21
|
Kulkarni K, Arasappa R, Prasad M K, Zutshi A, Chand PK, Murthy P, Philip M, Muralidharan K. Risperidone versus olanzapine in the acute treatment of Persistent Delusional Disorder: A retrospective analysis. Psychiatry Res 2017; 253:270-273. [PMID: 28411574 DOI: 10.1016/j.psychres.2017.02.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 01/01/2017] [Accepted: 02/03/2017] [Indexed: 10/19/2022]
Abstract
There is a dearth of prospective trials studying treatment response in Persistent Delusional Disorder (PDD) to guide clinical practice. Available retrospective data indicate good response to second-generation antipsychotics (SGAs). We selected the data of patients prescribed either olanzapine or risperidone from a retrospective chart review of PDD (n=455) at our centre. We compared the two groups olanzapine (n =86) versus risperidone (n =280) on dose, drug adherence, response and adverse effects. The two groups were comparable on socio-demographic and clinical characteristics of PDD. There was no statistically significant difference between the two groups on adherence (>80%) and response to treatment (>52% good response). Olanzapine was effective at lower mean chlorpromazine equivalents than risperidone. Logistic regression analysis identified shorter mean duration of illness, good adherence and absence of substance dependence as predictors of good response to both drugs. Our study indicates that acute PDD responds well to treatment with both risperidone and olanzapine, provided adherence can be ensured. In the absence of specific treatment guidelines and randomized controlled trials for PDD, our analysis reaffirms the efficacy of SGAs.
Collapse
Affiliation(s)
- Karishma Kulkarni
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore-560029, Karnataka, India
| | - Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore-560029, Karnataka, India
| | - Krishna Prasad M
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore-560029, Karnataka, India
| | - Amit Zutshi
- Consultant Psychiatrist, Epworth Hospital, Camberwell, Victoria - 3124 & Honorary Consultant, Department of Psychiatry, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Australia
| | - Prabhat K Chand
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore-560029, Karnataka, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore-560029, Karnataka, India
| | - Mariamma Philip
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences (INI), Bangalore-560029, Karnataka, India
| | - Kesavan Muralidharan
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore-560029, Karnataka, India.
| |
Collapse
|
22
|
Kalmady SV, Shivakumar V, Arasappa R, Subramaniam A, Gautham S, Venkatasubramanian G, Gangadhar BN. Clinical correlates of hippocampus volume and shape in antipsychotic-naïve schizophrenia. Psychiatry Res Neuroimaging 2017; 263:93-102. [PMID: 28371658 DOI: 10.1016/j.pscychresns.2017.03.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 03/09/2017] [Accepted: 03/20/2017] [Indexed: 01/25/2023]
Abstract
While volume deficit of hippocampus is an established finding in schizophrenia, very few studies have examined large sample of patients without the confounding effect of antipsychotic treatment. Concurrent evaluation of hippocampus shape will offer additional information on the hippocampal aberrations in schizophrenia. In this study, we analyzed the volume and shape of hippocampus in antipsychotic-naïve schizophrenia patients (N=71) in comparison to healthy controls (N=82). Using 3-T MRI data, gray matter (GM) volume (anterior and posterior sub-divisions) and shape of the hippocampus were analyzed. Schizophrenia patients had significant hippocampal GM volume deficits (specifically the anterior sub-division) in comparison to healthy controls. There were significant positive correlations between anterior hippocampus volume and psychopathology scores of positive syndrome. Shape analyses revealed significant inward deformation of bilateral hippocampal surface in patients. In conclusion, our study findings add robust support for volume deficit in hippocampus in antipsychotic-naïve schizophrenia. Hippocampal shape deficits in schizophrenia observed in this study map to anterior CA1 sub-region. The differential relationship of anterior hippocampus (but not posterior hippocampus) with clinical symptoms is in tune with the findings in animal models. Further systematic studies are needed to evaluate the relationship between these hippocampal gray matter deficits with white matter and functional connectivity to facilitate understanding the hippocampal network abnormalities in schizophrenia.
Collapse
Affiliation(s)
- Sunil Vasu Kalmady
- The Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India; Translational Psychiatry Laboratory, Cognitive Neurobiology Division, Neurobiology Research Centre, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Venkataram Shivakumar
- The Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India; Translational Psychiatry Laboratory, Cognitive Neurobiology Division, Neurobiology Research Centre, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Rashmi Arasappa
- The Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Aditi Subramaniam
- The Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - S Gautham
- The Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Ganesan Venkatasubramanian
- The Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India; Translational Psychiatry Laboratory, Cognitive Neurobiology Division, Neurobiology Research Centre, National Institute of Mental Health and Neuro Sciences, Bangalore, India.
| | - Bangalore N Gangadhar
- The Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| |
Collapse
|
23
|
Kulkarni K, Arasappa R, Prasad K, Zutshi A, Chand P, Murthy P, Kesavan M. Comorbid depressive symptoms in persistent delusional disorder: A retrospective study from India. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BackgroundPrevious studies have reported depressive symptoms in patients with persistent delusional disorder (PDD). Patients with PDD and depression may need antidepressants for treatment.AimThe aim of the study was to compare the sociodemographic profile, clinical presentation and treatment response in patients with PDD with and without comorbid depressive symptoms.MethodsWe conducted a retrospective chart review of patients diagnosed with PDD (ICD-10) from 2000 to 2014 (n = 455). We divided the patients into PDD + depression (n = 187) and PDD only (n = 268) for analysis.ResultsOf the 187 patients with PDD + D, only eighteen (3.9%) were diagnosed with syndromal depression. There were no significant differences in sociodemographic profile including sex, marital and socioeconomic status (all P > 0.05). PDD + D group had a significantly younger age at onset ([PDD + D: 30.6 9.2 years vs. PDD: 33.5 11.1 years]; t = 2.9, P < 0.05). There was no significant difference between the clinical presentation including mode of onset, the main theme of their delusion and secondary delusions (all P > 0.3). However, comorbid substance dependence was significantly higher in patients with PDD only. (χ2 = 5.3, P = 0.02). In terms of treatment, response to antipsychotics was also comparable ([> 75% response: PDD + D = 77/142 vs. PDD = 106/179); χ2 = 1.9, P = 0.3). There was a significant difference between the two groups in terms of antidepressant treatment ([PDD + D = 32/187; 17% vs PDD: 17/268; 6%), χ2 = 12.9, P = 0.001).DiscussionPatients with PDD + D had significantly earlier onset of illness. These patients may require antidepressants for treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Collapse
|
24
|
Affiliation(s)
- Karishma R Kulkarni
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - M Krishna Prasad
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Amit Zutshi
- Department of Psychiatry, Epworth Hospital, Camberwell, Victoria 3124, Australia
| | - Prabhat K Chand
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Kesavan Muralidharan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| |
Collapse
|
25
|
Kulkarni K, Arasappa R, Prasad K, Zutshi A, Chand P, Muralidharan K, Murthy P. A comparison of risperidone and olanzapine in the acute treatment of persistent delusional disorder: Data from a retrospective chart review. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.2011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IntroductionThere is a lack of pharmacological trials studying drug response in Persistent Delusional Disorder (PDD) to guide clinical practice. Available reviews of retrospective data indicate good response to second-generation antipsychotics, but even such data from India is sparse.Objectives and aimsWe aimed to compare the response of acute PDD to risperidone and olanzapine in our retrospective review.MethodsWe conducted a retrospective chart review of patients diagnosed with PDD (ICD-10) from 2000 to 2014 (n = 455) at our Center. We selected the data of patients prescribed either olanzapine or risperidone for the purpose of this analysis. We extracted data about dose, drug compliance and response, adverse effects, number of follow-up visits and hospitalizations. The study was approved by the Institute Ethics Committee.ResultsA total of 280/455 (61%) were prescribed risperidone and 86/455 (19%) olanzapine. The remaining (n = 89; 20%) had received other antipsychotics. The two groups were comparable in socio-demographic and clinical characteristics of PDD. Compliance was good and comparable in both groups (> 80%, P = 0.2). Response to treatment was comparable in both groups (85% partial response and > 52% good response, all P > 0.3). Olanzapine was effective at lower mean chlorpromazine equivalents than risperidone (240 vs. 391, P < 0.05).ConclusionOur study indicates a good response to both risperidone and olanzapine, if compliance to treatment can be ensured. In the absence of specific treatment guidelines for PDD, second-generation antipsychotics like risperidone and olanzapine offer good treatment options for this infrequently encountered and difficult to treat psychiatric disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Collapse
|
26
|
Kulkarni KR, Arasappa R, Prasad KM, Zutshi A, Chand PK, Muralidharan K, Murthy P. Clinical Presentation and Course of Persistent Delusional Disorder: Data From a Tertiary Care Center in India. Prim Care Companion CNS Disord 2016; 18:15m01883. [PMID: 27247844 DOI: 10.4088/pcc.15m01883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Despite its long history as a psychiatric diagnosis, little is known about the sociodemographic and clinical profile of persistent delusional disorder (PDD) or its subtypes, treatment response, and outcomes, particularly in India. We examined the clinical characteristics and course of PDD in patients presenting to a tertiary neuropsychiatry center in India. METHOD A retrospective chart review of patients diagnosed with PDD (ICD-10) between January 2000 and May 2014 was conducted. Sociodemographic and clinical data including age at onset, total duration of the illness, clinical symptoms and treatment, hospitalizations, occupational functioning, and follow-up were extracted from the files. The study was approved by the institute ethics committee. RESULTS The sample (N = 455) consisted of 236 men and 219 women. The mean age at onset was 32.36 ± 10.47 years. The most common delusion was infidelity (n = 203, 44.6%) followed by persecution (n = 149, 32.7%). Hallucinations were present in 78 (17.1%), depressive symptoms in 187 (41.1%), and comorbid substance dependence in 61 (13.4%) subjects; 141 subjects (31.0%) had a family history of mental illness. Follow-up data were available for 308 subjects, of whom 285 (92.5%) reported good compliance with medication. Of the subjects, 163 (52.9%) showed a good response to treatment. The diagnosis of PDD remained unchanged in 274 of 308 subjects (88.9%). CONCLUSION In our center, PDD appears to be uncommon and has a near-equal gender representation. Infidelity was the most common delusion, which is in contrast to the reported literature. The diagnosis of PDD appears to be stable with good response to atypical antipsychotics if compliance can be ensured.
Collapse
Affiliation(s)
- Karishma R Kulkarni
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, Karnataka, India
| | - Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, Karnataka, India
| | - Krishna M Prasad
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, Karnataka, India
| | - Amit Zutshi
- Epworth Hospital, Camberwell, Victoria 3124, Australia
| | - Prabhat K Chand
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, Karnataka, India
| | - Kesavan Muralidharan
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, Karnataka, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, Karnataka, India
| |
Collapse
|
27
|
Kalmady SV, Shivakumar V, Gautham S, Arasappa R, Jose DA, Venkatasubramanian G, Gangadhar BN. Dermatoglyphic correlates of hippocampus volume: Evaluation of aberrant neurodevelopmental markers in antipsychotic-naïve schizophrenia. Psychiatry Res 2015; 234:113-20. [PMID: 26385539 DOI: 10.1016/j.pscychresns.2015.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 07/23/2015] [Accepted: 09/02/2015] [Indexed: 12/31/2022]
Abstract
Schizophrenia is a disorder of aberrant neurodevelopment is marked by abnormalities in brain structure and dermatoglyphic traits. However, the link between these two (i.e. dermatoglyphic parameters and brain structure) which share ectodermal origin and common developmental window has not been explored extensively. The current study examined dermatoglyphic correlates of hippocampal volume in antipsychotic-naïve schizophrenia patients in comparison with matched healthy controls. Ridge counts and asymmetry measures for palmar inter-digital areas (a-b, b-c, c-d) were obtained using high resolution digital scans of palms from 89 schizophrenia patients [M:F=48:41] and 48 healthy controls [M:F=30:18]. Brain scans were obtained for subset of subjects including 26 antipsychotic-naïve patients [M:F=13:13] and 29 healthy controls [M:F=19:10] using 3 T-MRI. Hippocampal volume and palmar ridge counts were measured by blinded raters with good inter-rater reliability using valid methods. Directional asymmetry (DA) of b-c and bilateral hippocampal volume were significantly lower in patients than controls. Significant positive correlation was found between DA and ridge count of b-c with bilateral anterior hippocampal volume. Study demonstrates the utility of dermatoglyphic markers in identifying structural changes in the brain which may form the basis for neurodevelopmental pathogenesis in schizophrenia.
Collapse
Affiliation(s)
- Sunil V Kalmady
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India; Translational Psychiatry Laboratory, Neurobiology Research Centre, NIMHANS, Bangalore, India
| | - Venkataram Shivakumar
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India; Translational Psychiatry Laboratory, Neurobiology Research Centre, NIMHANS, Bangalore, India
| | - S Gautham
- Translational Psychiatry Laboratory, Neurobiology Research Centre, NIMHANS, Bangalore, India
| | - Rashmi Arasappa
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India; Translational Psychiatry Laboratory, Neurobiology Research Centre, NIMHANS, Bangalore, India
| | - Dania A Jose
- Translational Psychiatry Laboratory, Neurobiology Research Centre, NIMHANS, Bangalore, India
| | - Ganesan Venkatasubramanian
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India; Translational Psychiatry Laboratory, Neurobiology Research Centre, NIMHANS, Bangalore, India.
| | - B N Gangadhar
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India; Translational Psychiatry Laboratory, Neurobiology Research Centre, NIMHANS, Bangalore, India
| |
Collapse
|
28
|
Arasappa R, Rao NP, Venkatasubramanian G, Reddy NN, Behere RV, Sivakumar PT, Gangadhar BN. Rimonabant-induced depression in schizophrenia. Indian J Psychiatry 2014; 56:205. [PMID: 24891716 PMCID: PMC4040076 DOI: 10.4103/0019-5545.130513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rashmi Arasappa
- The Metabolic Clinic in Psychiatry, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore - 560 029, Karnataka, India. E-mail:
| | - Naren P Rao
- The Metabolic Clinic in Psychiatry, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore - 560 029, Karnataka, India. E-mail:
| | - Ganesan Venkatasubramanian
- The Metabolic Clinic in Psychiatry, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore - 560 029, Karnataka, India. E-mail:
| | - Nalini N Reddy
- The Metabolic Clinic in Psychiatry, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore - 560 029, Karnataka, India. E-mail:
| | - Rishikesh V Behere
- The Metabolic Clinic in Psychiatry, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore - 560 029, Karnataka, India. E-mail:
| | - Palanimuthu T Sivakumar
- The Metabolic Clinic in Psychiatry, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore - 560 029, Karnataka, India. E-mail:
| | - Bangalore N Gangadhar
- The Metabolic Clinic in Psychiatry, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore - 560 029, Karnataka, India. E-mail:
| |
Collapse
|
29
|
|
30
|
Hariprasad VR, Arasappa R, Varambally S, Srinath S, Gangadhar BN. Feasibility and efficacy of yoga as an add-on intervention in attention deficit-hyperactivity disorder: An exploratory study. Indian J Psychiatry 2013; 55:S379-84. [PMID: 24049203 PMCID: PMC3768216 DOI: 10.4103/0019-5545.116317] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
CONTEXT Attention deficit-hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders. Stimulant medication is frequently used in management, with significant adverse effects. There is a growing interest in complementary treatments like yoga. AIMS To study the effects of yoga as a complementary therapy in children with moderate to severe ADHD. SETTINGS AND DESIGN The study was performed on children (consent was taken from parents) admitted in a child psychiatry unit using an open-label exploratory study. MATERIALS AND METHODS Children between 5 and 16 years of age diagnosed with ADHD and co-operative for yoga were included. Subjects with other serious psychiatric and medical illnesses were excluded. The participants were given yoga training daily during their in-patient stay. They were rated on Conners' abbreviated rating scale - (CARS), ADHD-rating scale-IV (ADHD - RS IV) and clinical global impression (CGI)-Severity, at the beginning of study, at discharge and subsequently at the end of 1(st), 2(nd) and 3(rd) month by a research associate not involved in yoga instruction. Paired t-test was employed to compare the means of scores between baseline and follow-ups. RESULTS A total of 9 children (8 males, 1 female) were recruited into the study. All, but one were on medications. An average of 8 yoga training sessions was given to subjects. They were able to learn yoga reasonably well. There was a significant improvement in the ADHD symptoms as assessed on CARS (P-0.014), ADHD-RS IV (P=0.021) and CGI- S scales (P=0.004) at the time of discharge.
Collapse
Affiliation(s)
- V R Hariprasad
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | | | | | | |
Collapse
|
31
|
Jayaram N, Varambally S, Behere RV, Venkatasubramanian G, Arasappa R, Christopher R, Gangadhar BN. Effect of yoga therapy on plasma oxytocin and facial emotion recognition deficits in patients of schizophrenia. Indian J Psychiatry 2013; 55:S409-13. [PMID: 24049210 PMCID: PMC3768223 DOI: 10.4103/0019-5545.116318] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
CONTEXT Yoga therapy has been demonstrated to be useful in treatment of negative symptoms and improving the socio-occupational functioning and emotion recognition deficits in antipsychotic-stabilized schizophrenia patients. Oxytocin has been recently implicated in social cognition deficits in schizophrenia. The effect of yoga therapy on oxytocin levels in schizophrenia has not been studied. AIMS This study aimed to assess the effect of yoga therapy on symptoms, socio-occupational functioning, facial emotion recognition deficits and plasma oxytocin levels in antipsychotic stabilized schizophrenia patients. SETTINGS AND DESIGN Randomized controlled study on 43 consenting, medication stabilized patients with schizophrenia in a tertiary psychiatric center using yoga intervention and waitlisted groups. MATERIALS AND METHODS A total of 43 schizophrenia patients were randomized to yoga group (n=15) or waitlist group (n=28). Patients in the yoga group received training in a specific yoga therapy module for schizophrenia. Patients in both groups were continued on stable antipsychotic medication. Assessments included scale for assessment of positive symptoms, scale for assessment of negative symptoms, socio-occupational functioning scale and tool for recognition of emotions in neuropsychiatric disorders (TRENDS) and plasma oxytocin levels; performed at baseline and at the end of 1 month. RESULTS A total of 15 patients in the yoga group and 12 in waitlist group completed the study. The yoga therapy group showed a significant improvement in socio-occupational functioning, performance on TRENDS (P<0.001) and plasma increase in oxytocin levels (P=0.01) as compared with the waitlist group. CONCLUSION The study supported the role of add-on yoga therapy in management of schizophrenia and demonstrated an improvement in endogenous plasma oxytocin levels in schizophrenia patients receiving yoga therapy.
Collapse
Affiliation(s)
- N Jayaram
- Department of Psychiatry, Advanced Centre for Yoga, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | | | | | | | | | | |
Collapse
|
32
|
Venkatasubramanian G, Rao NP, Arasappa R, Kalmady SV, Gangadhar BN. A Longitudinal Study of Relation between Side-effects and Clinical Improvement in Schizophrenia: Is There a Neuro-metabolic Threshold for Second Generation Antipsychotics? Clin Psychopharmacol Neurosci 2013; 11:24-7. [PMID: 23678351 PMCID: PMC3650294 DOI: 10.9758/cpn.2013.11.1.24] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 09/20/2012] [Accepted: 10/16/2012] [Indexed: 11/25/2022]
Abstract
Objective Classical studies demonstrated Neuroleptic Induced Extrapyramidal Side-effects (NIES; Neuroleptic threshold) to correlate with the efficacy of first generation antipsychotics. Second generation antipsychotics (SGAs), in addition to the extrapyramidal side effects, are also associated with metabolic side effects. This prospective study on antipsychotic-naïve schizophrenia patients, for the first-time, examined concurrently the relationship between clinical improvement and these side-effects NIES and Neuroleptic Induced Metabolic Side-effects. Methods Thirty six-antipsychotic-naïve schizophrenia (DSM-IV) patients were examined at baseline and after 5 weeks of treatment with antipsychotics. At baseline and follow-up, we recorded the body mass index (BMI) and assessed psychopathology using Scale for Assessment of Positive-symptoms (SAPS) and Scale for Assessment of Negative-symptoms (SANS), extrapyramidal symptoms using Simpson-Angus Extra Pyramidal Scale (SAEPS) and improvement using Clinical Global Impression Improvement (CGI). Results After treatment, patients showed significant reduction in SAPS (baseline, 27.97±14.47; follow-up, 14.63±13.25; p<0.001) and SANS total scores (baseline, 63.77±28.96; follow-up, 49.30±28.77; p=0.001) and a significant increase in BMI (baseline, 18.5±3.37; follow-up, 19.13±3.17; p<0.001). At follow-up CGI-Improvement score was (2.55±0.65) and SAEPS score was (0.8±1.32). CGI-Improvement score had a significant negative correlation with magnitude of increase in BMI (rs=-0.39; p=0.01) and SAEPS symptom score at follow-up (rs=-0.58; p<0.001). In addition, magnitude of increase in BMI showed positive correlation with the magnitude of reduction in SAPS total score (rs=0.33; p=0.04). Conclusion The study findings suggest a possible relation between clinical improvement and antipsychotic-induced neuroleptic as well as metabolic side-effects in schizophrenia. Though the mechanism of this relation is yet to be elucidated, insulin signaling pathways and lipid homeostasis are potential mechanisms in addition to the established neurotransmitter hypothesis. Theoretically findings support the novel hypothetical construct of 'Neuro-Metabolic threshold' in the treatment of schizophrenia.
Collapse
Affiliation(s)
- Ganesan Venkatasubramanian
- The Metabolic Clinic in Psychiatry, Department of Psychiatry Translational Psychiatry Laboratory, Cognitive Neurobiology Division, Neurobiology Research Centre, National Institute of Mental Health & Neurosciences [NIMHANS], Bangalore, India
| | | | | | | | | |
Collapse
|
33
|
Kalmady SV, Venkatasubramanian G, Arasappa R, Rao NP. Evolutionary genetic analyses of MEF2C gene: implications for learning and memory in Homo sapiens. Asian J Psychiatr 2013; 6:56-9. [PMID: 23380319 DOI: 10.1016/j.ajp.2012.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 08/07/2012] [Accepted: 08/20/2012] [Indexed: 11/29/2022]
Abstract
MEF2C facilitates context-dependent fear conditioning (CFC) which is a salient aspect of hippocampus-dependent learning and memory. CFC might have played a crucial role in human evolution because of its advantageous influence on survival of species. In this study, we analyzed 23 orthologous mammalian gene sequences of MEF2C gene to examine the evidence for positive selection on this gene in Homo sapiens using Phylogenetic Analysis by Maximum Likelihood (PAML) and HyPhy software. Both PAML Bayes Empirical Bayes (BEB) and HyPhy Fixed Effects Likelihood (FEL) analyses supported significant positive selection on 4 codon sites in H. sapiens. Also, haplotter analysis revealed significant ongoing positive selection on this gene in Central European population. The study findings suggest that adaptive selective pressure on this gene might have influenced human evolution. Further research on this gene might unravel the potential role of this gene in learning and memory as well as its pathogenetic effect in certain hippocampal disorders with evolutionary basis like schizophrenia.
Collapse
Affiliation(s)
- Sunil V Kalmady
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore, India
| | | | | | | |
Collapse
|
34
|
Venkatasubramanian G, Arasappa R, Rao NP, Gangadhar BN. Digit ratio (2D:4D) asymmetry and Schneiderian first rank symptoms: implications for cerebral lateralisation theories of schizophrenia. Laterality 2012; 16:499-512. [PMID: 21128162 DOI: 10.1080/1357650x.2010.499910] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Schneiderian first rank symptoms (FRS) in schizophrenia have been hypothesised to be secondary to aberrant cerebral lateralisation over the course of human evolution. The ratio of length of second digit to fourth digit (2D:4D) has been put forward as a potential indicator of cerebral lateralisation. This study examined 2D:4D and its asymmetry in antipsychotic-naïve schizophrenia patients (N=79) in comparison with healthy controls (N=75). Psychopathology was assessed using Scales for Assessment of Positive and Negative Symptoms. FRS assessment was performed as per established descriptions. The digit lengths (2D & 4D) were measured using a digital vernier caliper with good inter-rater reliability. Female schizophrenia patients showed significantly lower 2D:4D than female healthy controls. Mean 2D:4D asymmetry index was significantly lower in male schizophrenia patients than male healthy controls. FRS status had significant effect on left 2D:4D as well as 2D:4D asymmetry index, the patients with FRS having the lowest values. Our study findings support association between schneiderian FRS and low 2D:4D as well as low 2D:4D asymmetry index. Since 2D:4D is linked with limbic asymmetry, our study findings offer further support to the cerebral lateralisation theories of schizophrenia.
Collapse
Affiliation(s)
- Ganesan Venkatasubramanian
- Metabolic Clinic in Psychiatry, Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore 560029, Karnataka, India.
| | | | | | | |
Collapse
|
35
|
Virupaksha HS, Kalmady SV, Shivakumar V, Arasappa R, Venkatasubramanian G, Gangadhar BN. Volume and asymmetry abnormalities of insula in antipsychotic-naive schizophrenia: a 3-tesla magnetic resonance imaging study. Indian J Psychol Med 2012; 34:133-9. [PMID: 23162188 PMCID: PMC3498775 DOI: 10.4103/0253-7176.101778] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
CONTEXT Insula, which is a vital brain region for self-awareness, empathy, and sensory stimuli processing, is critically implicated in schizophrenia pathogenesis. Existing studies on insula volume abnormalities report inconsistent findings potentially due to the evaluation of 'antipsychotic-treated' schizophrenia patients as well as suboptimal methodology. AIM To understand the role of insula in schizophrenia. MATERIALS AND METHODS In this first-time 3-T magnetic resonance imaging study, we examined antipsychotic-naive schizophrenic patients (N=30) and age-, sex-, handedness- and education-matched healthy controls (N=28). Positive and negative symptoms were scored with good interrater reliability (intraclass correlation coefficient (ICC)>0.9) by using the scales for negative and positive symptoms. Gray matter volume of insula and its anterior/posterior subregions were measured by using a three-dimensional, interactive, semiautomated software based on the valid method with good interrater reliability (ICC>0.85). Intracranial volume was automatically measured by using the FreeSurfer software. RESULTS Patients had significantly deficient gray matter volumes of left (F=33.4; P<0.00001) and right (F=11.9; P=0.001) insula after controlling for the effects of age, sex, and intracranial volume. Patients with predominantly negative symptoms had a significantly deficient right posterior insula volume than those with predominantly positive symptoms (F=6.3; P=0.02). Asymmetry index analysis revealed anterior insular asymmetry to be significantly reversed (right>left) in male patients in comparison with male controls (left>right) (t=2.7; P=0.01). CONCLUSIONS Robust insular volume deficits in antipsychotic-naive schizophrenia support intrinsic role for insula in pathogenesis of this disorder. The first-time demonstration of a relationship between right posterior insular deficit and negative symptoms is in tune with the background neurobiological literature. Another novel observation of sex-specific anterior insular asymmetry reversal in patients supports evolutionary postulates of schizophrenia pathogenesis.
Collapse
Affiliation(s)
- Harve Shanmugam Virupaksha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | | | | | | | | |
Collapse
|
36
|
Rao NP, Venkatasubramanian G, Arasappa R, Gangadhar BN. Relationship between corpus callosum abnormalities and schneiderian first-rank symptoms in antipsychotic-naive schizophrenia patients. J Neuropsychiatry Clin Neurosci 2011; 23:155-62. [PMID: 21677243 DOI: 10.1176/jnp.23.2.jnp155] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The corpus callosum (CC), has been hypothesized to be implicated in the pathogenesis of schizophrenia; however, the findings from magnetic resonance imaging studies are conflicting. Moreover, the relationship between first-rank-symptoms (FRS) and CC abnormalities in schizophrenia is yet to be examined. The authors examined CC morphometry, based on Witelson's method, in antipsychotic-naïve-schizophrenia patients in comparison with matched healthy-control subjects. Patients had significantly smaller CC, splenium, and isthmus areas than control subjects. A novel finding of the study is that only those without FRS differed from control subjects, but not those with FRS. Study findings support a neuro-developmental hypothesis and possible connectivity abnormalities in symptom-genesis.
Collapse
Affiliation(s)
- Naren P Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | | | | | | |
Collapse
|
37
|
Kalyani BG, Venkatasubramanian G, Arasappa R, Rao NP, Kalmady SV, Behere RV, Rao H, Vasudev MK, Gangadhar BN. Neurohemodynamic correlates of 'OM' chanting: A pilot functional magnetic resonance imaging study. Int J Yoga 2011; 4:3-6. [PMID: 21654968 PMCID: PMC3099099 DOI: 10.4103/0973-6131.78171] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: A sensation of vibration is experienced during audible ‘OM’ chanting. This has the potential for vagus nerve stimulation through its auricular branches and the effects on the brain thereof. The neurohemodynamic correlates of ‘OM’ chanting are yet to be explored. Materials and Methods: Using functional Magnetic Resonance Imaging (fMRI), the neurohemodynamic correlates of audible ‘OM’ chanting were examined in right-handed healthy volunteers (n=12; nine men). The ‘OM’ chanting condition was compared with pronunciation of “ssss” as well as a rest state. fMRI analysis was done using Statistical Parametric Mapping 5 (SPM5). Results: In this study, significant deactivation was observed bilaterally during ‘OM’ chanting in comparison to the resting brain state in bilateral orbitofrontal, anterior cingulate, parahippocampal gyri, thalami and hippocampi. The right amygdala too demonstrated significant deactivation. No significant activation was observed during ‘OM’ chanting. In contrast, neither activation nor deactivation occurred in these brain regions during the comparative task – namely the ‘ssss’ pronunciation condition. Conclusion: The neurohemodynamic correlates of ‘OM’ chanting indicate limbic deactivation. As similar observations have been recorded with vagus nerve stimulation treatment used in depression and epilepsy, the study findings argue for a potential role of this ‘OM’ chanting in clinical practice.
Collapse
Affiliation(s)
- Bangalore G Kalyani
- Department of Psychiatry, Advanced Center for Yoga, National Institute of Mental Health and Neurosciences, Bangalore - 560 029, India
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Vinay HR, Sundar GSK, Behere RV, Arasappa R, Rao NP, Venkatasubramanian G, Sivakumar PT, Gangadhar BN. Effect of risperidone on metabolic parameters in antipsychotic-naïve schizophrenia: A prospective one year follow-up study. Asian J Psychiatr 2011; 4:73-4. [PMID: 23050920 DOI: 10.1016/j.ajp.2010.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 08/19/2010] [Accepted: 09/08/2010] [Indexed: 10/18/2022]
Affiliation(s)
- H R Vinay
- The Metabolic Clinic in Psychiatry, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Behere RV, Arasappa R, Jagannathan A, Varambally S, Venkatasubramanian G, Thirthalli J, Subbakrishna DK, Nagendra HR, Gangadhar BN. Effect of yoga therapy on facial emotion recognition deficits, symptoms and functioning in patients with schizophrenia. Acta Psychiatr Scand 2011; 123:147-53. [PMID: 20846271 DOI: 10.1111/j.1600-0447.2010.01605.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Facial emotion recognition deficits have been consistently demonstrated in schizophrenia and can impair socio-occupational functioning in these patients. Treatments to improve these deficits in antipsychotic-stabilized patients have not been well studied. Yoga therapy has been described to improve functioning in various domains in schizophrenia; however, its effect on FERD is not known. METHOD Antipsychotic-stabilized patients randomized to receive Yoga (n=27), Exercise (n=17) or Waitlist group (n=22) were assessed at baseline, 2nd month, and 4th month of follow-up by raters blind to group status. Assessments included Positive and Negative Syndrome Scale (PANSS), Socio-Occupational Functioning Scale (SOFS), and Tool for Recognition of Emotions in Neuropsychiatric DisorderS (TRENDS). RESULTS There was a significant positive correlation between baseline FERD and socio-occupational functioning (r=0.3, P=0.01). Paired samples t test showed significant improvement in positive and negative symptoms, socio-occupational functioning and performance on TRENDS (P<0.05) in the Yoga group, but not in the other two groups. Maximum improvement occurred at the end of 2 months, and improvement in positive and negative symptoms persisted at the end of 4 months. CONCLUSION Yoga therapy can be a useful add-on treatment to improve psychopathology, FERD, and socio-occupational functioning in antipsychotic-stabilized patients with schizophrenia.
Collapse
Affiliation(s)
- R V Behere
- Departments of Psychiatry Psychiatric Social Work Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore Swami Vivekananda Yoga Anusandhana Samsthana University, Bangalore, India
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Rao NP, Arasappa R, Reddy NN, Venkatasubramanian G, Reddy YCJ. Emotional interference in obsessive-compulsive disorder: a neuropsychological study using optimized emotional Stroop test. Psychiatry Res 2010; 180:99-104. [PMID: 20546928 DOI: 10.1016/j.psychres.2009.10.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Revised: 10/04/2009] [Accepted: 10/27/2009] [Indexed: 11/16/2022]
Abstract
Contents related to threat and associated cognitive processes are proposed to be the central characteristic of obsessive-compulsive disorder (OCD) according to 'threat-relatedness hypothesis'. However, evidence for attention bias toward emotionally salient stimuli using the emotional Stroop test is equivocal. This discrepancy could be due to methodological issues, mainly differences in the lexical characters of words. Fifty Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) OCD patients (23 washers and 27 checkers) and 50 age-, handedness- and sex-matched healthy controls were examined with an optimized version of the emotional Stroop test (i.e., with lexically matched words) and color-Stroop test. Twenty-four patients were clinically symptomatic and 26 were remitted. OCD patients had significantly higher attention bias only for negative OCD stimuli as calculated by negatively valenced OCD interference score but not for neutral or non-OCD emotional stimuli. Symptomatic patients had significantly higher bias, but not the remitted patients. There were no significant correlations between other illness-related variables (age at onset, illness duration, and medication dose) and Stroop test performance. Study findings suggest the presence of selective emotional bias for OCD relevant stimuli in these patients and this bias is potentially related to symptomatic status. These observations are in tune with the threat-relatedness hypothesis.
Collapse
Affiliation(s)
- Naren Prahlada Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | | | | | | | | |
Collapse
|
41
|
Venkatasubramanian G, Arasappa R, Christopher R, Gangadhar BN. Neuropharmacology of schizophrenia: is there a role for leptin? Clin Chem Lab Med 2010; 48:895-6. [PMID: 20518646 DOI: 10.1515/cclm.2010.158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
42
|
Venkatasubramanian G, Arasappa R, Rao NP, Behere RV, Gangadhar BN. Adjuvant metformin worsens psychosis in schizophrenia: a case report. Prim Care Companion J Clin Psychiatry 2010; 12. [PMID: 20694127 DOI: 10.4088/pcc.09l00801yel] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
43
|
Rao NP, Kalmady S, Arasappa R, Venkatasubramanian G. Clinical correlates of thalamus volume deficits in anti-psychotic-naïve schizophrenia patients: A 3-Tesla MRI study. Indian J Psychiatry 2010; 52:229-35. [PMID: 21180407 PMCID: PMC2990822 DOI: 10.4103/0019-5545.70975] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
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-naïve 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-naïve 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-naïve 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.
Collapse
Affiliation(s)
- Naren P Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore - 560 029, India
| | | | | | | |
Collapse
|
44
|
Rao NP, Arasappa R, Reddy NN, Venkatasubramanian G, Gangadhar BN. Antithetical asymmetry in schizophrenia and bipolar affective disorder: a line bisection study. Bipolar Disord 2010; 12:221-9. [PMID: 20565429 DOI: 10.1111/j.1399-5618.2010.00811.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Evolutionary theories link the pathogenesis of psychosis with anomalous brain asymmetry. Research shows that aberrant lateralization is linked to schizophrenia with elevated rates of left-handedness and reversal of normal cerebral asymmetries. However, lateralization is underexamined in bipolar affective disorder (BPAD) and the available literature suggests the possibility of greater lateralization, which is diametrically opposite to what is observed in schizophrenia. For the first time, we report concurrent analyses of asymmetry in BPAD and schizophrenia using a line bisection task. METHODS We examined 164 subjects (31 patients with BPAD in remission, 30 patients with schizophrenia, and 103 healthy controls) using a two-hand line bisection task with established methodology. Raters with good inter-rater reliability (intraclass correlation coefficient > 0.8) measured deviation from the center. Task performance was compared using analysis of covariance with age, sex, and education as covariates. RESULTS Study groups did not differ significantly on age, sex, and handedness (p > 0.06). Patients (both schizophrenia and BPAD) had significantly more errors in identifying the center than controls (p < 0.001). Patients with schizophrenia bisected fewer lines at center than controls and BPAD subjects (p < 0.001). Using their right hand, schizophrenia patients had significant rightward deviation and BPAD patients had leftward deviation (p = 0.001). A significant interaction between diagnosis and direction of deviation (p = 0.01) was noted, with significant rightward deviation in schizophrenia and a trend toward leftward deviation in BPAD. CONCLUSIONS Study findings suggest attenuation of normal pseudoneglect in schizophrenia and accentuation of normal pseudoneglect in BPAD, indicating lesser lateralization in schizophrenia and possibly greater lateralization in BPAD. From an evolutionary perspective, schizophrenia and BPAD might have antithetical origins.
Collapse
Affiliation(s)
- Naren P Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | | | | | | |
Collapse
|
45
|
Venkatasubramanian G, Arasappa R, Rao NP, Behere RV, Kalmady S, Gangadhar BN. Inverse relationship between serum high density lipoprotein and negative syndrome in antipsychotic-naive schizophrenia. Clin Chem Lab Med 2010; 48:95-8. [PMID: 19929755 DOI: 10.1515/cclm.2010.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recent literature suggests a role for apolipoprotein L (apoL) aberrations in the pathogenesis of schizophrenia. ApoL is almost exclusively associated with apolipoprotein A-I in high-density lipoproteins (HDLs). The objective of this study was to examine the correlation between symptom scores and serum HDL in antipsychotic-naive schizophrenia patients. METHODS In this cross-sectional study, 60 antipsychotic-naive schizophrenia patients were systematically examined for their symptom scores, with good inter-rater reliability. Concurrently, an overnight fasting serum lipid profile from these patients was assessed. RESULTS Serum HDL had a significant inverse correlation with a total negative syndrome score (rho=-0.43; p=0.001). CONCLUSIONS The study observation supports the potential role for HDL abnormalities in the genesis of negative symptoms in schizophrenia.
Collapse
Affiliation(s)
- Ganesan Venkatasubramanian
- The Metabolic Clinic in Psychiatry, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
| | | | | | | | | | | |
Collapse
|
46
|
Bharadwaj B, Arasappa R, Venkatasubramanian G, Gangadhar BN. Successful use of adjuvant phytoestrogens in schizoaffective disorder: a case report. Prim Care Companion J Clin Psychiatry 2009; 11:268. [PMID: 19956468 DOI: 10.4088/pcc.08l00716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
47
|
Reddy NN, Rao NP, Venkatasubramanian G, Arasappa R, Behere RV, Divakaran A, Sivakumar PT, Gangadhar BN. Rimonabant-induced catatonia in schizophrenia: A case report. Obes Res Clin Pract 2009; 3:237-9. [DOI: 10.1016/j.orcp.2009.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 03/31/2009] [Accepted: 04/23/2009] [Indexed: 11/25/2022]
|
48
|
Behere RV, Venkatasubramanian G, Arasappa R, Reddy N, Gangadhar BN. Effect of risperidone on emotion recognition deficits in antipsychotic-naïve schizophrenia: a short-term follow-up study. Schizophr Res 2009; 113:72-6. [PMID: 19545977 DOI: 10.1016/j.schres.2009.05.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 05/25/2009] [Accepted: 05/26/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Facial emotion recognition deficits [FERD] have been consistently demonstrated in treated schizophrenia patients. FERD in treatment-naïve patients and the effect of antipsychotics are yet to be explored. AIMS To examine for FERD in antipsychotic-naïve schizophrenia patients and the effect of short-term atypical antipsychotic treatment on FERD. METHODS Twenty-five antipsychotic-naïve schizophrenia [DSM-IV] patients and 30 age-, sex-, and education-matched healthy control subjects were assessed for FERD using the Tool for Recognition of Emotions in Neuropsychiatric DisorderS [TRENDS] - a culturally sensitive and valid tool. Psychopathology was assessed using SAPS and SANS. Performance of patients on TRENDS and psychopathology was re-assessed after short-term exposure to risperidone. RESULTS At baseline, the patients made significantly greater errors in recognition of negative emotions of fear and disgust which improved on follow-up. This improvement was influenced by severity of baseline negative symptoms. CONCLUSION Risperidone treatment can improve disgust recognition deficits in patients with schizophrenia.
Collapse
Affiliation(s)
- Rishikesh V Behere
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | | | | | | |
Collapse
|
49
|
Danivas V, Kalmady S, Arasappa R, Behere RV, Rao NP, Venkatasubramanian G, Gangadhar BN. Inferior parietal lobule volume and schneiderian first-rank symptoms in antipsychotic-naïve schizophrenia: a 3-tesla MRI study. Indian J Psychol Med 2009; 31:82-7. [PMID: 21938100 PMCID: PMC3168090 DOI: 10.4103/0253-7176.63578] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND As per Frith's neuro-cognitive model, inferior parietal lobule (IPL) is implicated in the pathogenesis of Schneiderian first-rank symptoms (FRS) in schizophrenia. The specific role of IPL structural abnormalities in the pathogenesis of FRS is yet to be ascertained. MATERIALS AND METHODS Using 3-tesla MRI scanner, this first-time study examined antipsychotic-naïve schizophrenia patients ( n = 28) (patients with FRS [FRS +]: N = 14, M: F = 7:7; and patients without FRS [FRS-]: N = 14, M: F = 7:7) in comparison with sex-, handedness-, education- and socioeconomic status-matched healthy controls (n = 14, M: F = 7:7). The volume of IPL was measured using a three-dimensional, interactive, semi-automated analysis, with good inter-rater reliability. RESULTS FRS + patients showed significant volume deficit in right IPL in comparison with healthy controls (F = 4.0; P=.028) after controlling for the potential confounding effects of age, sex and intracranial volume. CONCLUSIONS Right IPL volume deficit in FRS+patients adds further support to the Frith's model of FRS in schizophrenia.
Collapse
Affiliation(s)
- Vijay Danivas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - Sunil Kalmady
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - Rashmi Arasappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - Rishikesh V. Behere
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - Naren P. Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - B. N. Gangadhar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| |
Collapse
|