1
|
Pandey A, Joseph R, Arumugham SS, Thirthalli J. Erroneous conclusions about the long-term cognitive effects of electroconvulsive therapy. Psychiatry Res 2024; 335:115864. [PMID: 38547602 DOI: 10.1016/j.psychres.2024.115864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/16/2024] [Indexed: 04/14/2024]
Affiliation(s)
- Abhinav Pandey
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Rini Joseph
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| |
Collapse
|
2
|
Uppinkudru C, Pathak H, Kumar K R, S B, Bagali K, Pantoji M, Ezhumalai N, Parlikar R, Shah V, Balachander S, Sreeraj VS, Mehta UM, Sinha P, Arumugham SS, Venkatasubramanian G, Thirthalli J. Development, validation and clinical utility of short-term adverse-effects of electroconvulsive therapy (SAVE) checklist. Psychiatry Res 2024; 335:115839. [PMID: 38503006 DOI: 10.1016/j.psychres.2024.115839] [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: 01/24/2024] [Revised: 02/27/2024] [Accepted: 03/03/2024] [Indexed: 03/21/2024]
Abstract
Electroconvulsive therapy (ECT) is one of the most effective treatments in psychiatry. However, it has many cognitive and non-cognitive adverse effects (AEs). There are lacunae in the literature on systematic assessment of non-cognitive AEs. There is a need for a standard, comprehensive and specific clinical tool to evaluate this. Hence, a checklist of short-term AEs of ECT (SAVE) with a 2-phase assessment was developed. Content validation was done using 15 experts' ratings and predefined content validity ratio and index (CVR and CVI) in a two-stage modified Delphi method. The checklist had a good CVR and CVI with a final tool of 39 items. The tool was sensitive and identified the non-cognitive AEs after ECT. Cardiovascular and musculoskeletal systems displayed the highest incidence. Many participants exhibited delayed recovery in orientation, gait, and stance, highlighting a necessity for meticulous monitoring. SAVE is the first standardised tool to assess short-term ECT-related AEs systematically. This checklist likely identifies clinically significant incidences of adverse effects. Its regular use may enhance the safety of ECT and patient comfort by supporting early identification and intervention for AEs. However, given the transient nature of AEs, further studies are needed to determine their predictive validity for long-term consequences.
Collapse
Affiliation(s)
- Chithra Uppinkudru
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Harsh Pathak
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Raj Kumar K
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Bridgit S
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Kiran Bagali
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Makarand Pantoji
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Nathiya Ezhumalai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Rujuta Parlikar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Vyoma Shah
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Srinivas Balachander
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India.
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Preeti Sinha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| |
Collapse
|
3
|
Vinod P, Thatikonda NS, Malo PK, Bhaskarapillai B, Arumugham SS, Janardhan Reddy YC. Comparative efficacy of repetitive transcranial magnetic stimulation protocols for obsessive-compulsive disorder: A network meta-analysis. Asian J Psychiatr 2024; 94:103962. [PMID: 38377642 DOI: 10.1016/j.ajp.2024.103962] [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: 10/31/2023] [Revised: 01/15/2024] [Accepted: 02/07/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) has been found to be helpful for the treatment of obsessive-compulsive disorder (OCD). However, the relative efficacy of different rTMS protocols is unclear. OBJECTIVE To conduct a systematic review and network meta-analysis (NMA) of published literature to compare the relative efficacy of different rTMS protocols for decreasing Yale-Brown Obsessive Compulsive Severity (Y-BOCS) scores in patients with OCD. METHOD Relevant articles published between 1985 to September 2023 were searched from the Cochrane Central Register of Controlled Trials, PubMed and PsycInfo. Double or single-blinded randomized controlled studies conducted on patients with OCD comparing an active rTMS protocol with either another active or sham rTMS protocol were included. Network meta-analysis (NMA) was conducted using a frequentist approach. Standardized mean difference (SMD) of change in Y-BOCS scores was calculated employing Hedge's g. Pairwise meta-analysis using random effects model was conducted which was extended to the NMA using restricted maximum likelihood estimation procedure. Surface under the cumulative ranking (SUCRA) probabilities were used to rank the interventions. RESULTS Excitatory rTMS of the bilateral dorsolateral prefrontal cortex (DLPFC), inhibitory rTMS of right DLPFC, inhibitory as well as excitatory rTMS of bilateral medial prefrontal cortex/anterior cingulate cortex (mPFC/ACC) and inhibitory rTMS of bilateral supplementary motor area (SMA) were superior to sham stimulation. The DLPFC and mPFC/ACC protocols had a higher probability of being among the top-ranked interventions. The majority of studies had a modest sample size and at least some concerns in the risk of bias assessment. CONCLUSION rTMS targeting either the medial or lateral prefrontal cortices is a promising intervention for resistant OCD. There is a need to confirm these findings in large systematic studies.
Collapse
Affiliation(s)
- Pratibha Vinod
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Navya Spurthi Thatikonda
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Palash Kumar Malo
- Centre for Brain Research, Indian Institute of Science, Bengaluru 560012, India
| | | | - Shyam Sundar Arumugham
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), India.
| | - Y C Janardhan Reddy
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), India
| |
Collapse
|
4
|
Ganaraja SV, Sharma LP, Arumugham SS, Vaishya S, Srinivas D. Compulsive programming in a patient with deep brain stimulation for obsessive-compulsive disorder. Asian J Psychiatr 2024; 95:103980. [PMID: 38447286 DOI: 10.1016/j.ajp.2024.103980] [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: 01/04/2024] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Sneha V Ganaraja
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Lavanya P Sharma
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Sandeep Vaishya
- Department of Neurosurgery, Fortis Hospital, New Delhi, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| |
Collapse
|
5
|
Arumugham SS, Thirthalli J, Reddy YCJ. Is ECT effective in treatment-refractory OCD? Concerns with the data and analysis of a recently published randomized-controlled trial. J Affect Disord 2024; 344:617-618. [PMID: 37863365 DOI: 10.1016/j.jad.2023.10.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/04/2023] [Accepted: 10/08/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India.
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India
| |
Collapse
|
6
|
Sharma LP, Balachander S, Thatikonda NS, Ganesh UM, Kishore C, Bhattacharya M, Thamby A, Ts J, Narayanaswamy JC, Arumugham SS, Reddy YJ. Long-term impact of the COVID-19 pandemic on obsessive-compulsive disorder. Psychiatry Res 2024; 331:115625. [PMID: 38141264 DOI: 10.1016/j.psychres.2023.115625] [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: 06/09/2023] [Revised: 11/18/2023] [Accepted: 11/23/2023] [Indexed: 12/25/2023]
Abstract
There is limited data on the long-term effect of the COVID-19 pandemic on obsessive-compulsive disorder (OCD). We report on the course of a cohort of individuals with OCD followed-up over a period of one year during the first wave of the COVID-19 pandemic in India. A cohort of 240 individuals registered at a specialty OCD clinic was regularly followed-up using standardized rating tools at three months, six months, and one year into the onset of the COVID-19 pandemic in India. These were compared with clinical ratings recorded in a comparable historical cohort of 207 individuals with OCD, followed up during a non-pandemic year. The pandemic and non-pandemic (historical control) cohorts did not differ in illness severity and rate of relapse. It was found that COVID-19-related anxiety declined over time. Among those patients who were treatment responders prior to the pandemic, COVID-19-related anxiety and non-adherence to medication predicted a relapse of symptoms. Contrary to our expectations, the rate of relapse and illness trajectory in the pandemic cohort did not differ from the non-pandemic cohort, suggesting that the pandemic did not impact our largely medication-adherent cohort. Adherence to treatment seemed to have a protective effect during the pandemic.
Collapse
Affiliation(s)
- Lavanya P Sharma
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka 560029, India
| | - Srinivas Balachander
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka 560029, India.
| | - Navya Spurthi Thatikonda
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka 560029, India
| | - Uma Maheswari Ganesh
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka 560029, India; Department of Clinical Psychology, NIMHANS, Bengaluru, Karnataka, India
| | - Chethana Kishore
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka 560029, India
| | - Mahashweta Bhattacharya
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka 560029, India; Department of Clinical Psychology, NIMHANS, Bengaluru, Karnataka, India
| | - Abel Thamby
- Senior Psychiatry Registrar, The Royal Melbourne Hospital and Northwestern Mental Health, Melbourne, VIC, Australia
| | - Jaisoorya Ts
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka 560029, India
| | | | - Shyam Sundar Arumugham
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka 560029, India
| | - Yc Janardhan Reddy
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka 560029, India
| |
Collapse
|
7
|
Radhika P, Basavarajappa C, Dahale AB, Arumugham SS, Jaisoorya TS, Jain S, Murthy P. Exploring the early history of convulsive therapies at the Mysore Government Mental Hospital (currently NIMHANS). Asian J Psychiatr 2023; 89:103747. [PMID: 37647785 DOI: 10.1016/j.ajp.2023.103747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/12/2023] [Revised: 07/26/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE The paper describes the introduction, and early use of chemically and electrically induced convulsive therapies, at the Mysore Government Mental Hospital (MGMH), now the National Institute of Mental Health and Neuro Sciences, Bangalore, India. Cardiazol and ammonium chloride were used at MGMH before the introduction of electroconvulsive therapy (ECT). The study examines the early history, clinical correlates and outcome of convulsive therapies and attempts to contextualize how local conditions influenced implementation. METHOD Three sets of archival case-records from 1938 to 1948, each of a period of 9 months following the implementation of a particular mode of convulsive therapy were reviewed. RESULTS During the examined timeframe, 40 patients received cardiazol, 95 ammonium chloride and 50 unmodified ECT. Schizophrenia was the commonest clinical indication for convulsive therapy across all modalities of treatment. When outcomes were examined, 45%, 48.4% and 62% of patients were clinically reported to have been either cured/improved after receiving cardiazol, ammonium chloride and ECT respectively. Those receiving cardiazol had a high mortality of 22.5%, compared to 3.1% for ammonium chloride and 4% with ECT. CONCLUSIONS Convulsive therapies were one of the first somatic psychiatric treatments, introduced around 1930s and 1940s all over the world, including in India. Our archival records suggest that many international ideas about somatic treatments were quickly adopted in India. Electroconvulsive therapy and other novel neuromodulatory interventions continue to be used and actively researched in India.
Collapse
Affiliation(s)
- P Radhika
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Chethan Basavarajappa
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Ajit Bhalchandra Dahale
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - T S Jaisoorya
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India.
| |
Collapse
|
8
|
Yatham LN, Arumugham SS, Kesavan M, Ramachandran K, Murthy NS, Saraf G, Ouyang Y, Bond DJ, Schaffer A, Ravindran A, Ravindran N, Frey BN, Daigneault A, Beaulieu S, Lam RW, Kondapuram N, Reddy MS, Bhandary RP, Ashok MV, Ha K, Ahn YM, Milev R, Wong H, Reddy YCJ. Duration of Adjunctive Antidepressant Maintenance in Bipolar I Depression. N Engl J Med 2023; 389:430-440. [PMID: 37530824 DOI: 10.1056/nejmoa2300184] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
BACKGROUND Antidepressants are used to treat acute depression in patients with bipolar I disorder, but their effect as maintenance treatment after the remission of depression has not been well studied. METHODS We conducted a multisite, double-blind, randomized, placebo-controlled trial of maintenance of treatment with adjunctive escitalopram or bupropion XL as compared with discontinuation of antidepressant therapy in patients with bipolar I disorder who had recently had remission of a depressive episode. Patients were randomly assigned in a 1:1 ratio to continue treatment with antidepressants for 52 weeks after remission or to switch to placebo at 8 weeks. The primary outcome, assessed in a time-to-event analysis, was any mood episode, as defined by scores on scales measuring symptoms of hypomania or mania, depression, suicidality, and mood-episode severity; additional treatment or hospitalization for mood symptoms; or attempted or completed suicide. Key secondary outcomes included the time to an episode of mania or hypomania or depression. RESULTS Of 209 patients with bipolar I disorder who participated in an open-label treatment phase, 150 who had remission of depression were enrolled in the double-blind phase in addition to 27 patients who were enrolled directly. A total of 90 patients were assigned to continue treatment with the prescribed antidepressant for 52 weeks (52-week group) and 87 were assigned to switch to placebo at 8 weeks (8-week group). The trial was stopped before full recruitment was reached owing to slow recruitment and funding limitations. At 52 weeks, 28 of the patients in the 52-week group (31%) and 40 in the 8-week group (46%) had a primary-outcome event. The hazard ratio for time to any mood episode in the 52-week group relative to the 8-week group was 0.68 (95% confidence interval [CI], 0.43 to 1.10; P = 0.12 by log-rank test). A total of 11 patients in the 52-week group (12%) as compared with 5 patients in the 8-week group (6%) had mania or hypomania (hazard ratio, 2.28; 95% CI, 0.86 to 6.08), and 15 patients (17%) as compared with 35 patients (40%) had recurrence of depression (hazard ratio, 0.43; 95% CI, 0.25 to 0.75). The incidence of adverse events was similar in the two groups. CONCLUSIONS In a trial involving patients with bipolar I disorder and a recently remitted depressive episode, adjunctive treatment with escitalopram or bupropion XL that continued for 52 weeks did not show a significant benefit as compared with treatment for 8 weeks in preventing relapse of any mood episode. The trial was stopped early owing to slow recruitment and funding limitations. (Funded by the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00958633.).
Collapse
Affiliation(s)
- Lakshmi N Yatham
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| | - Shyam Sundar Arumugham
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| | - Muralidharan Kesavan
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| | - Kanchana Ramachandran
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| | - Nithyananda S Murthy
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| | - Gayatri Saraf
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| | - Yongdong Ouyang
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| | - David J Bond
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| | - Ayal Schaffer
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| | - Arun Ravindran
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| | - Nisha Ravindran
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| | - Benicio N Frey
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| | - Andrée Daigneault
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| | - Serge Beaulieu
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| | - Raymond W Lam
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| | - Nithin Kondapuram
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| | - M S Reddy
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| | - R P Bhandary
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| | - Mysore V Ashok
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| | - Kyooseob Ha
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| | - Yong Min Ahn
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| | - Roumen Milev
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| | - Hubert Wong
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| | - Y C Janardhan Reddy
- From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea
| |
Collapse
|
9
|
Khanra S, Reddy P, Giménez-Palomo A, Park CHJ, Panizzutti B, McCallum M, Arumugham SS, Umesh S, Debnath M, Das B, Venkatasubramanian G, Ashton M, Turner A, Dean OM, Walder K, Vieta E, Yatham LN, Pacchiarotti I, Reddy YCJ, Goyal N, Kesavan M, Colomer L, Berk M, Kim JH. Metabolic regulation to treat bipolar depression: mechanisms and targeting by trimetazidine. Mol Psychiatry 2023; 28:3231-3242. [PMID: 37386057 PMCID: PMC10618096 DOI: 10.1038/s41380-023-02134-8] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/14/2023] [Accepted: 06/13/2023] [Indexed: 07/01/2023]
Abstract
Bipolar disorder's core feature is the pathological disturbances in mood, often accompanied by disrupted thinking and behavior. Its complex and heterogeneous etiology implies that a range of inherited and environmental factors are involved. This heterogeneity and poorly understood neurobiology pose significant challenges to existing drug development paradigms, resulting in scarce treatment options, especially for bipolar depression. Therefore, novel approaches are needed to discover new treatment options. In this review, we first highlight the main molecular mechanisms known to be associated with bipolar depression-mitochondrial dysfunction, inflammation and oxidative stress. We then examine the available literature for the effects of trimetazidine in said alterations. Trimetazidine was identified without a priori hypothesis using a gene-expression signature for the effects of a combination of drugs used to treat bipolar disorder and screening a library of off-patent drugs in cultured human neuronal-like cells. Trimetazidine is used to treat angina pectoris for its cytoprotective and metabolic effects (improved glucose utilization for energy production). The preclinical and clinical literature strongly support trimetazidine's potential to treat bipolar depression, having anti-inflammatory and antioxidant properties while normalizing mitochondrial function only when it is compromised. Further, trimetazidine's demonstrated safety and tolerability provide a strong rationale for clinical trials to test its efficacy to treat bipolar depression that could fast-track its repurposing to address such an unmet need as bipolar depression.
Collapse
Affiliation(s)
- Sourav Khanra
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Preethi Reddy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Anna Giménez-Palomo
- Bipolar and Depressive Disorders Unit, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Mental Health Biomedical Research Networking Center (CIBERSAM), Madrid, Spain
| | - Chun Hui J Park
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Bruna Panizzutti
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Madeleine McCallum
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Shreekantiah Umesh
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Monojit Debnath
- Department of Human Genetics, NIMHANS, Bengaluru, Karnataka, India
| | - Basudeb Das
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Melanie Ashton
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Alyna Turner
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Olivia M Dean
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Ken Walder
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Mental Health Biomedical Research Networking Center (CIBERSAM), Madrid, Spain
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders Unit, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Mental Health Biomedical Research Networking Center (CIBERSAM), Madrid, Spain
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Nishant Goyal
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Muralidharan Kesavan
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Lluc Colomer
- Bipolar and Depressive Disorders Unit, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Mental Health Biomedical Research Networking Center (CIBERSAM), Madrid, Spain
| | - Michael Berk
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia.
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.
| | - Jee Hyun Kim
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia.
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.
| |
Collapse
|
10
|
Reddy PV, Bojappen N, Reddy RP, Arumugham SS, Muralidharan K. Neurocognitive Deficits in Recently Diagnosed Young Remitted Bipolar I Disorder and At-Risk Subjects: Potential Endophenotypes? Indian J Psychol Med 2023; 45:390-396. [PMID: 37483584 PMCID: PMC10357910 DOI: 10.1177/02537176231165414] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Background Neurocognitive deficits have been reported consistently in euthymic bipolar disorder (BD) across studies. Endophenotype potential of such deficits have been reported in a few studies. However, data from the Indian subcontinent is sparse, and no studies had a sample (patients and high-risk group) aged 20-25 years, which is the actual risk period for developing BD. We studied cognitive deficits, as a potential endophenotype for BD, in recently diagnosed BD (FEM-first episode mania) in remission, young unaffected first-degree relatives (HR) of patients with BD, and healthy controls (HC). Methods Cross-sectional study design using convenient sampling was employed. We recruited FEM (n = 25), HR (n = 25), and age-matched HC (n = 25) between 18 and 30 years. All HR subjects were <25 years of age, which is the period of vulnerability for BD. All the groups were screened using MINI Version 6. Neurocognitive assessments were done using the NIMHANS neuropsychology battery. The cognitive domains assessed were processing speed, attention, working memory, executive functions, and visual and verbal memory. Results The three groups were comparable in age and sex (all P > 0.06). The mean (SD) age of the FEM subjects was 23.7 (3.47) years, and the mean duration of illness was 5.92 (2.94) months. Compared to the HC group, the FEM group performed poorly on multiple cognitive domains (all P < 0.05). Performance of the HR group was comparable to the FEM group, but they showed significantly poorer performance compared to HC on the verbal fluency test-controlled oral word association (COWA, F = 12.36, P = 0.001), and the visual learning and memory test-complex figure test-immediate recall (CFT-IR, F = 8.10 and p = 0.001). Conclusions Cognition is impaired very early in the course of BD. Visual memory and executive function (verbal fluency) have endophenotypic potential. These findings are particularly important given that the HR group were still within the vulnerable period to develop BD. These findings imply a tremendous potential for early diagnosis and prevention by early interventions in BD.
Collapse
Affiliation(s)
- Preethi V. Reddy
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Nandhini Bojappen
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Rajkumari P. Reddy
- Dept. of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Shyam Sundar Arumugham
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Kesavan Muralidharan
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| |
Collapse
|
11
|
Thatikonda NS, Vinod P, Balachander S, Bhaskarpillai B, Arumugham SS, Reddy YJ. Efficacy of Repetitive Transcranial Magnetic Stimulation on Comorbid Anxiety and Depression Symptoms in Obsessive-Compulsive Disorder: A Meta-Analysis of Randomized Sham-Controlled Trials. Can J Psychiatry 2023; 68:407-417. [PMID: 35989677 PMCID: PMC10331254 DOI: 10.1177/07067437221121112] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To systematically evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in reducing comorbid anxiety and depressive symptoms in patients with obsessive-compulsive disorder (OCD). METHODS Three electronic databases were searched for randomized, sham-controlled clinical trials evaluating rTMS for the treatment of OCD. Hedge's g was calculated as the effect size for anxiety/depression symptom severity (primary outcome) and OCD severity (secondary outcome). Subgroup analyses and meta-regression analyses were carried out to evaluate the most promising target and whether a reduction in OCD severity moderates the change in anxiety or depression scores. RESULTS Twenty studies (n = 688) were included in the meta-analysis. rTMS had small-medium effect size on OCD (Hedge's g = 0.43; 95% confidence interval [CI]: [0.20, 0.65]; P < 0.001), anxiety (Hedge's g = 0.3; 95% CI: [0.11, 0.48]; P = 0.001) and depression (Hedge's g = 0.24; 95% CI: [0.07, 0.40]; P = 0.003) symptoms. Subgroup analysis showed that protocols targeting dorsolateral prefrontal cortex (DLPFC) were effective for 3 outcome measures. The change in anxiety, but not depression severity, was moderated by a change in OCD symptom scores. However, the findings are uncertain as a majority of the studies had some concerns or a high risk of bias. CONCLUSIONS Active rTMS protocol targeting DLPFC is effective in reducing the comorbid anxiety/depression symptoms along with OCD severity. The antidepressant effect is not moderated by the anti-obsessive effect of rTMS.
Collapse
Affiliation(s)
- Navya Spurthi Thatikonda
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Pratibha Vinod
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Srinivas Balachander
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | | | - Shyam Sundar Arumugham
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Y.C. Janardhan Reddy
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| |
Collapse
|
12
|
Reddy S, Arumugham SS, Teotia V, Pyda PK. Accelerated deep transcranial magnetic stimulation using iTBS protocol for refractory obsessive-compulsive disorder. Brain Stimul 2023; 16:556-557. [PMID: 36809848 DOI: 10.1016/j.brs.2023.02.007] [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] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/12/2023] [Accepted: 02/12/2023] [Indexed: 02/22/2023] Open
Affiliation(s)
- Sachin Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India.
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Vasundhra Teotia
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Pavan Kumar Pyda
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| |
Collapse
|
13
|
Srinivas D, Manohar H, Sharma E, Arumugham SS, Sharma LP, Ghosh S. Deep Brain Stimulation of the bilateral anteromedial Globus Pallidus internus in an adolescent with refractory tourette syndrome and comorbid obsessive compulsive disorder- A case report. Brain Stimul 2022; 15:1415-1417. [PMID: 36265790 DOI: 10.1016/j.brs.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/17/2022] [Accepted: 10/11/2022] [Indexed: 12/30/2022] Open
Affiliation(s)
- Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.
| | - Harshini Manohar
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.
| | - Eesha Sharma
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.
| | - Shyam Sundar Arumugham
- Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.
| | - Lavanya P Sharma
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.
| | - Sreyoshi Ghosh
- National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.
| |
Collapse
|
14
|
Arumugham SS, Praharaj SK, Shreekantiah U, Sreeraj VS, Roy C, Shenoy S, Purohith AN, Chithra U, Bagali KB, Venkataramaiah S, Nanjundaiah GKK, Thennarasu K, Kumar CN, Goyal N, Das B, Mehta UM, Muralidharan K, Venkatasubramanian G, Sinha P, Thirthalli J. Clinical efficacy and neurobiological correlates of electroconvulsive therapy in patients with clozapine-resistant/intolerant schizophrenia: study protocol of multi-site parallel arm double-blind randomized sham-controlled study. Wellcome Open Res 2022; 7:212. [PMID: 37953926 PMCID: PMC10636350 DOI: 10.12688/wellcomeopenres.18028.2] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 11/14/2023] Open
Abstract
Background: A substantial proportion of patients with treatment resistant schizophrenia do not respond well or partially to clozapine, with a subset that does not tolerate an adequate trial of clozapine. Electroconvulsive therapy (ECT) is regarded as one of the augmenting options, but there is a lack of high-quality evidence for this practice. This protocol describes a double-blind randomised sham-controlled modified-ECT trial to evaluate its efficacy in patients with clozapine resistant/intolerant schizophrenia. The study also involves multimodal investigations to identify the response predictors and the mechanistic basis of modified ECT in this population. Methods: One hundred consenting schizophrenia patients with resistance/intolerance to clozapine referred by clinicians for ECT would be randomly assigned to receive true ECT or sham ECT at three study centers. Sham ECT would mimic all the procedures of modified ECT including anaesthesia and muscle relaxation, except the electrical stimulation. After a blinded course, non-responders to sham ECT would be offered open-label true ECT. Clinical assessments, neurocognitive assessments and multimodal investigations (magnetic resonance imaging [MRI], electroencephalography, heart rate variability, investigative transcranial magnetic stimulation-transcranial direct current stimulation, gene polymorphism) would be conducted at baseline and repeated after the end of the trial, as well as open-label ECT course. The trial would evaluate the improvement in positive symptoms (scale for assessment of positive symptoms) of schizophrenia as the primary outcome measure with prediction of this change by resting-state functional-MRI based brain-connectivity as the second primary objective. Registration: Clinical Trial Registry of India (Reg no: CTRI/2021/05/033775) on 24 th May 2021.
Collapse
Affiliation(s)
- Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Samir K. Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | | | - Vanteemar S. Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Chandramouli Roy
- Central Institute of Psychiatry, Ranchi, Jharkhand, 834006, India
| | - Sonia Shenoy
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Abhiram Narasimhan Purohith
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Uppinkudru Chithra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Kiran Basawaraj Bagali
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Sudhir Venkataramaiah
- Department of Neuroanaesthsia and Neuro Critical Care, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, 560029, India
| | - Gopala Krishna Kadarapura Nanjundaiah
- Department of Neuroanaesthsia and Neuro Critical Care, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, 560029, India
| | - Kandavel Thennarasu
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, 560029, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Nishant Goyal
- Central Institute of Psychiatry, Ranchi, Jharkhand, 834006, India
| | - Basudeb Das
- Central Institute of Psychiatry, Ranchi, Jharkhand, 834006, India
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Kesavan Muralidharan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Preeti Sinha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| |
Collapse
|
15
|
Sinha P, Shreekantiah U, Goyal N, Sreeraj VS, Arumugham SS, Samantaray S, Jammigumpula A, Nanjundaiah GKK, Venkataramaiah S, Thennarasu K, Roy C, Purohith AN, Shenoy S, Kumar CN, Shivakumar V, Udupa K, Muralidharan K, Venkatasubramanian G, Thirthalli J, Praharaj SK, Mehta UM. Study protocol for evaluating the clinical efficacy and neurobiological correlates of sequential treatment with tDCS primed iTBS and ECT in treatment-resistant depression. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.18192.1] [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: 11/20/2022] Open
Abstract
Background: Treatment-resistant depression is a burdensome condition. Intermittent theta burst stimulation (iTBS) of the left dorsolateral prefrontal cortex is considered a treatment option in early course of resistance with a proportion of such patients responding to it. Preliminary evidence suggests a role of priming iTBS stimulation with preconditioning using cathodal transcranial direct current stimulation (tDCS). This protocol describes a double-blind randomized sham-controlled study to evaluate the clinical efficacy and tolerability of tDCS-primed iTBS in the treatment of resistant depression. Non-responders to this trial will be offered open-label electroconvulsive therapy. All participants will undergo neurobiological investigations that will enable the identification of potential response predictors and mechanisms. Methods: Three hundred and fifty consenting patients with treatment resistant depression will be randomly assigned to receive 20–30 daily sessions of true-tDCS or sham-tDCS primed iTBS over left dorsolateral prefrontal cortex at three study centers. After this blinded sham-controlled trial, non-responders to the intervention will be offered open-label true ECT. Clinical assessments, neurocognitive assessments and multimodal investigations (magnetic resonance imaging, electroencephalography, heart rate variability, investigative transcranial magnetic stimulation-transcranial direct current stimulation, gene polymorphisms) will be conducted at baseline and repeated after the end of the trial, as well as open-label ECT course. The trial will evaluate the improvement in depressive symptoms (Hamilton depression rating scale) between the two groups as the primary outcome measure.
Collapse
|
16
|
Arumugham SS, Praharaj SK, Shreekantiah U, Sreeraj VS, Roy C, Shenoy S, Purohith AN, Chithra U, Bagali KB, Venkataramaiah S, Nanjundaiah GKK, Thennarasu K, Kumar CN, Goyal N, Das B, Mehta UM, Muralidharan K, Venkatasubramanian G, Sinha P, Thirthalli J. Clinical efficacy and neurobiological correlates of electroconvulsive therapy in patients with clozapine-resistant/intolerant schizophrenia: study protocol of multi-site parallel arm double-blind randomized sham-controlled study. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.18028.1] [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: 11/20/2022] Open
Abstract
Background: A substantial proportion of patients with treatment resistant schizophrenia do not respond well or partially to clozapine, with a subset that does not tolerate an adequate trial of clozapine. Electroconvulsive therapy (ECT) is regarded as one of the augmenting options, but there is a lack of high-quality evidence for this practice. This protocol describes a double-blind randomised sham-controlled modified-ECT trial to evaluate its efficacy in patients with clozapine resistant/intolerant schizophrenia. The study also involves multimodal investigations to identify the response predictors and the mechanistic basis of modified ECT in this population. Methods: One hundred consenting schizophrenia patients with resistance/intolerance to clozapine referred by clinicians for ECT would be randomly assigned to receive true ECT or sham ECT at three study centers. Sham ECT would mimic all the procedures of modified ECT including anaesthesia and muscle relaxation, except the electrical stimulation. After a blinded course, non-responders to sham ECT would be offered open-label true ECT. Clinical assessments, neurocognitive assessments and multimodal investigations (magnetic resonance imaging [MRI], electroencephalography, heart rate variability, investigative transcranial magnetic stimulation-transcranial direct current stimulation, gene polymorphism) would be conducted at baseline and repeated after the end of the trial, as well as open-label ECT course. The trial would evaluate the improvement in positive symptoms (scale for assessment of positive symptoms) of schizophrenia as the primary outcome measure with prediction of this change by resting-state functional-MRI based brain-connectivity as the second primary objective. Registration: Clinical Trial Registry of India (Reg no: CTRI/2021/05/033775) on 24th May 2021.
Collapse
|
17
|
Murthy NS, Balachander S, Nirmala BP, Pandian RD, Cherian AV, Arumugham SS, Reddy YCJ. Determinants of family functioning in caregivers of persons with obsessive-compulsive disorder. J Affect Disord 2022; 305:179-187. [PMID: 35247483 DOI: 10.1016/j.jad.2022.02.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/24/2021] [Revised: 01/16/2022] [Accepted: 02/22/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is known to cause significant burden to patients and their caregivers. However, there is limited data on its impact on family functioning, especially from families with an adult member having OCD. METHODS Four hundred subjects, which included treatment-seeking adult OCD patients (n = 200) and their caregivers (n = 200) were recruited. Patients were evaluated using the Mini International Neuropsychiatric Interview (MINI) and the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Caregivers were evaluated using the MINI, the Caregiver Strain Index (CSI), the Hamilton Anxiety Rating Scale (HAM-A), the Hamilton Depression Rating Scale (HAM-D), the Socio-Occupational Functioning Assessment Scale (SOFAS), the Family Accommodation Scale (FAS) and the Connor-David Resilience scale (CD-RISC) in a cross-sectional interview. Family functioning was measured using the OCD Family Functioning (OFF) Scale. Structural equation modeling (SEM) was carried out to evaluate the relationships between the patient and caregiver variables to predict family functioning. RESULTS From the best-fitting path model, we ascertained that OCD symptoms did not have a direct relationship with family dysfunction. Their effects were in turn was mediated by family accommodation, anxiety, caregiver stress/burden and depression. "Contamination & washing" was the only significant symptom dimension within the model. Caregiver resilience was found to predict only their individual functioning, and not family functioning. LIMITATIONS Study sample included patients from a tertiary care OCD service, only one caregiver from each patient's family was interviewed. CONCLUSIONS Evaluating family functioning, addressing it as part of interventional modules for patients and caregivers may help improving treatment outcomes.
Collapse
Affiliation(s)
- Nithyananda S Murthy
- OCD Clinic, National Institute of Mental Health & Neuro-Sciences (NIMHANS), Bangalore, India; Department of Psychiatric Social Work, NIMHANS, Bangalore, India
| | - Srinivas Balachander
- OCD Clinic, National Institute of Mental Health & Neuro-Sciences (NIMHANS), Bangalore, India; Department of Psychiatry, NIMHANS, Bangalore, India
| | - B P Nirmala
- Department of Psychiatric Social Work, NIMHANS, Bangalore, India
| | | | - Anish V Cherian
- OCD Clinic, National Institute of Mental Health & Neuro-Sciences (NIMHANS), Bangalore, India; Department of Psychiatric Social Work, NIMHANS, Bangalore, India
| | - Shyam Sundar Arumugham
- OCD Clinic, National Institute of Mental Health & Neuro-Sciences (NIMHANS), Bangalore, India; Department of Psychiatry, NIMHANS, Bangalore, India
| | - Y C Janardhan Reddy
- OCD Clinic, National Institute of Mental Health & Neuro-Sciences (NIMHANS), Bangalore, India; Department of Psychiatry, NIMHANS, Bangalore, India.
| |
Collapse
|
18
|
Sakhardande KA, Sharma LP, Arumugham SS. Pseudothrombocytopenia in a patient with bipolar type 2 disorder on lurasidone: A case report. Indian J Psychiatry 2022; 64:109-110. [PMID: 35400743 PMCID: PMC8992749 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_625_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/28/2021] [Revised: 10/03/2021] [Accepted: 11/30/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Kasturi Atmaram Sakhardande
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India. E-mail:
| | - Lavanya P Sharma
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India. E-mail:
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India. E-mail:
| |
Collapse
|
19
|
Rukmini S, Sudhir PM, Bhaskar A, Arumugham SS. Identifying mediators of cognitive behaviour therapy and exposure therapy for social anxiety disorder (SAD) using repeated measures. Journal of Affective Disorders Reports 2021. [DOI: 10.1016/j.jadr.2021.100194] [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: 10/20/2022] Open
|
20
|
Mehta UM, Ektare A, Jakhar J, Basavaraju R, Sanjay TN, Naik SS, Syed FA, Bhargav PH, Reddy PV, Kelkar RS, Arumugham SS, Kesavan M, Thirthalli J, Gangadhar BN. A transdiagnostic evaluation of cortical inhibition in severe mental disorders using Transcranial Magnetic Stimulation. J Psychiatr Res 2021; 143:364-369. [PMID: 34571321 DOI: 10.1016/j.jpsychires.2021.09.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/06/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
Multiple lines of investigations suggest the presence of cortical inhibition aberrations as central to the phenotypic manifestations of severe mental disorders. Transcranial Magnetic Stimulation (TMS) combined with electromyography can characterize these inhibitory processes in the motor cortex with satisfactory temporal precision. We examined TMS-evoked short- (SICI) and long-interval intracortical inhibition (LICI) and cortical silent period (CSP) as markers of GABAA- (SICI) and GABAB-mediated (LICI and CSP) cortical neurotransmission in symptomatic individuals with mania (n = 40), schizophrenia (n = 76), unipolar depression (n = 86), and OCD (n = 43), and compared them against similar recordings in healthy subjects (n = 125). We hypothesized transdiagnostic GABAA deficits across all the clinical groups and diagnosis-specific GABAB alterations in mania (increased) and OCD (decreased). After controlling for potential confounder variables (gender, education, benzodiazepine prescription, and motor threshold) using the ANCOVA, we observed no significant group difference in SICI (F = 1.04, P = 0.38), but a significant group effect in LICI (F = 16.29, P < 0.001) and CSP (F = 3.02, P = 0.018). Post-hoc analyses revealed that LICI was significantly reduced in OCD but increased in mania and schizophrenia with reference to the healthy group. Similarly, CSP was significantly reduced in OCD and depression groups as compared to the reference group. We observed that LICI and CSP, both followed similar descending gradients from mania through schizophrenia and depression to OCD; with significant elevation in mania, and reduction in depression and OCD, as compared to the healthy group. This pattern of GABAB-mediated cortical inhibition aberrations needs independent validation as potential state-markers of distinct clinical categories.
Collapse
Affiliation(s)
- Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India.
| | - Aboli Ektare
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Jitender Jakhar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Rakshathi Basavaraju
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Tarasingh N Sanjay
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Shalini S Naik
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Farooq Ali Syed
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Praerna Hemant Bhargav
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Preethi V Reddy
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Radhika Suneel Kelkar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Muralidharan Kesavan
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Bangalore N Gangadhar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| |
Collapse
|
21
|
Reddy YCJ, Arumugham SS, Balachander S. Cognitive-behavioral and related therapies for obsessive-compulsive and related disorders. Curr Opin Psychiatry 2021; 34:467-476. [PMID: 34292182 DOI: 10.1097/yco.0000000000000731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Cognitive behavioral therapy (CBT) with exposure and response prevention is the first-line treatment for obsessive-compulsive disorder (OCD) and related disorders such as body dysmorphic disorder (BDD). We review here recent developments in CBT and related therapies in treating OCD and related disorders. RECENT FINDINGS Superiority of CBT over medications in treating OCD is being questioned by some recent meta-analyses, nonetheless CBT continues to be the mainstay of treatment. Web-based therapies have been shown to be beneficial in treating at least mild-to-moderately ill patients. Mindfulness-based CBT, intensive residential treatment and Bergen 4-day concentrated exposure are also proving to be useful in treating OCD. Large well designed studies have demonstrated the efficacy CBT over supportive therapy in treating BDD. Research on the efficacy of CBT in treating hoarding disorder is accumulating. SUMMARY Efficacy of web-based CBT has a potential public health importance in that CBT may now become accessible to all and benefit at least mild-to-moderately ill patients who form most of the clinically ill sample. Similarly, efficacy of Bergen 4-day concentrated exposure will have a huge public health implication if the findings can be replicated in other centers across the world.
Collapse
Affiliation(s)
| | | | - Srinivas Balachander
- Obsessive-Compulsive Disorder (OCD) Clinic
- Accelerator Program for Discovery in Brain Disorders Using Stem Cells (ADBS)
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| |
Collapse
|
22
|
Arumugham SS, Srinivas D, Narayanaswamy JC, Jaisoorya TS, Kashyap H, Domenech P, Palfi S, Mallet L, Venkatasubramanian G, Reddy YJ. Identification of biomarkers that predict response to subthalamic nucleus deep brain stimulation in resistant obsessive-compulsive disorder: protocol for an open-label follow-up study. BMJ Open 2021; 11:e047492. [PMID: 34158304 PMCID: PMC8220486 DOI: 10.1136/bmjopen-2020-047492] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/26/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Deep brain stimulation (DBS) of bilateral anteromedial subthalamic nucleus (amSTN) has been found to be helpful in a subset of patients with severe, chronic and treatment-refractory obsessive-compulsive disorder (OCD). Biomarkers may aid in patient selection and optimisation of this invasive treatment. In this trial, we intend to evaluate neurocognitive function related to STN and related biosignatures as potential biomarkers for STN DBS in OCD. METHODS AND ANALYSIS Twenty-four subjects with treatment-refractory OCD will undergo open-label STN DBS. Structural/functional imaging, electrophysiological recording and neurocognitive assessment would be performed at baseline. The subjects would undergo a structured clinical assessment for 12 months postsurgery. A group of 24 healthy volunteers and 24 subjects with treatment-refractory OCD who receive treatment as usual would be recruited for comparison of biomarkers and treatment response, respectively. Baseline biomarkers would be evaluated as predictors of clinical response. Neuroadaptive changes would be studied through a reassessment of neurocognitive functioning, imaging and electrophysiological activity post DBS. ETHICS AND DISSEMINATION The protocol has been approved by the National Institute of Mental Health and Neurosciences Ethics Committee. The study findings will be disseminated through peer-reviewed scientific journals and scientific meetings.
Collapse
Affiliation(s)
- Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - T S Jaisoorya
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Himani Kashyap
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Philippe Domenech
- Univ Paris-Est Créteil, DMU CARE - Département Médical-Universitaire de Chirurgie et Anesthésie réanimation, DMU IMPACT, Département Médical-Universitaire de Psychiatrie et d'Addictologie, Hôpitaux Universitaires Henri Mondor, Creteil, France
- Univ of Paris 12 UPEC, Faculté de médecine, INSERM U955, Creteil, France
| | - Stéphane Palfi
- Univ Paris-Est Créteil, DMU CARE - Département Médical-Universitaire de Chirurgie et Anesthésie réanimation, DMU IMPACT, Département Médical-Universitaire de Psychiatrie et d'Addictologie, Hôpitaux Universitaires Henri Mondor, Creteil, France
- Univ of Paris 12 UPEC, Faculté de médecine, INSERM U955, Creteil, France
| | - Luc Mallet
- Institut du Cerveau, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
- Department of Mental Health and Psychiatry, University of Geneva, Geneva, Switzerland
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Yc Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| |
Collapse
|
23
|
Thamby A, Seshachala K, Sharma L, Thimmashetty VH, Balachander S, Shivakumar V, Hazari N, Chhabra H, Arumugham SS, Ts J, K M, Venkatasubramanian G, Reddy YCJ, Narayanaswamy JC. Transcranial direct current stimulation for treatment-resistant obsessive-compulsive disorder-A large case series. Asian J Psychiatr 2021; 60:102625. [PMID: 33930710 DOI: 10.1016/j.ajp.2021.102625] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/28/2020] [Revised: 02/26/2021] [Accepted: 03/04/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The present study is a large case series evaluating the benefits of transcranial direct current stimulation (tDCS) in treatment-resistant obsessive compulsive disorder (OCD). METHODS We reviewed the charts of 32 patients with treatment-resistant OCD who received 10-20 sessions of anodal pre-SMA tDCS. RESULTS Overall, 9 (28 %) showed at least partial response to tDCS at the end of 10-20 sessions [responders = 8 (25 %), partial responders = 1 (3%)]. Two out of three partial responders at the end of 10 sessions had response at the end of 20 sessions. CONCLUSIONS tDCS may benefit a proportion of patients with treatment-resistant OCD.
Collapse
Affiliation(s)
- Abel Thamby
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Karthik Seshachala
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Lavanya Sharma
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Vani Holebasavanahalli Thimmashetty
- Department of Psychiatry, WISER Neuromodulation Program, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Srinivas Balachander
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Venkataram Shivakumar
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Nandita Hazari
- Department of Psychiatry, Vidyasagar Institute of Mental Health, Neuro & Allied Sciences (VIMHANS), New Delhi, India
| | - Harleen Chhabra
- Department of Psychiatry, WISER Neuromodulation Program, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Jaisoorya Ts
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Mohanavelu K
- Defence Bioengineering & Electromedical Laboratory (DEBEL), DRDO, Bengaluru, 560093, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, WISER Neuromodulation Program, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Y C Janardhan Reddy
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India.
| |
Collapse
|
24
|
Thamby A, Balachander S, Ali SF, Arumugham SS, Ts J, Narayanaswamy JC, Janardhan Reddy YC. Naturalistic outcome of medication-naïve obsessive compulsive disorder treated with serotonin reuptake inhibitors. Asian J Psychiatr 2021; 60:102642. [PMID: 33930709 DOI: 10.1016/j.ajp.2021.102642] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/08/2021] [Accepted: 04/05/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The data on the course of obsessive compulsive disorder (OCD) is mostly derived from studying chronic, severely ill patients with varying degree of treatment resistance. We studied the course and outcome of OCD patients who were medication-naïve at initial assessment compared to those who were medicated. MATERIAL AND METHODS We analyzed the clinical chart data of all patients with a primary diagnosis of OCD attending a speciality OCD clinic in India during a specified period and compared outcome between medication-naïve (n = 75) and medicated (n = 117) patients. RESULTS The mean time to remission was shorter in the medication-naïve [18.99 months (95 % CI: 14.61-23.37)] compared to medicated [33.91 months (95 % CI: 27.55-40.28)] patients. The survival distribution of the two groups was significantly different as per the log-rank test (χ2 = 5.76, p = 0.02). In the Cox proportional hazards regression, medication-naïve status predicted time to remission. Overall, the rate of remission was the same in both groups (57 %). CONCLUSIONS Medication-naïve OCD patients seem to remit faster than the previously treated patients. Future prospective naturalistic studies can compare the outcome of medication naïve OCD patients treated with medications and CBT.
Collapse
Affiliation(s)
- Abel Thamby
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Srinivas Balachander
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Syed Farooq Ali
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Jaisoorya Ts
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India.
| | - Y C Janardhan Reddy
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| |
Collapse
|
25
|
Sharma LP, Balachander S, Thamby A, Bhattacharya M, Kishore C, Shanbhag V, Sekharan JT, Narayanaswamy JC, Arumugham SS, Reddy JYC. Impact of the COVID-19 Pandemic on the Short-Term Course of Obsessive-Compulsive Disorder. J Nerv Ment Dis 2021; 209:256-264. [PMID: 33625069 DOI: 10.1097/nmd.0000000000001318] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
ABSTRACT There is an understandable concern that obsessive-compulsive disorder (OCD) may worsen during the COVID-19 pandemic, but there are little empirical data. We report the impact of COVID-19 pandemic on the short-term course of OCD. A cohort of patients with a primary diagnosis of OCD (n = 240) who were on regular follow-up at a tertiary care specialty OCD clinic in India were assessed telephonically, about 2 months after the declaration of the pandemic ("pandemic" cohort). Data from the medical records of an independent set of patients with OCD (n = 207) who were followed up during the same period, 1 year prior, was used for comparison (historical controls). The pandemic group and historical controls did not differ in the trajectories of the Yale-Brown Obsessive-Compulsive Scale scores (chi-square likelihood ratio test of the group × time interaction = 2.73, p = 0.255) and relapse rate (21% vs. 20%; adjusted odds ratio, 0.81; 95% confidence interval, 0.41-1.59; p = 0.535). Preexisting contamination symptoms and COVID-19-related health anxiety measured by the COVID-Threat Scale did not predict relapse. Only a small proportion of patients (6%) reported COVID-19-themed obsessive-compulsive symptoms. The COVID-19 pandemic, at least in the short run, did not influence the course of illness.
Collapse
Affiliation(s)
| | | | - Abel Thamby
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry
| | - Mahashweta Bhattacharya
- Department of Clinical Psychology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | | | | | | | | | | | | |
Collapse
|
26
|
McGirr A, Vila-Rodriguez F, Cole J, Torres IJ, Arumugham SS, Keramatian K, Saraf G, Lam RW, Chakrabarty T, Yatham LN. Efficacy of Active vs Sham Intermittent Theta Burst Transcranial Magnetic Stimulation for Patients With Bipolar Depression: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e210963. [PMID: 33710288 PMCID: PMC7955269 DOI: 10.1001/jamanetworkopen.2021.0963] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Major depressive episodes in bipolar disorder are common and debilitating. Repetitive transcranial magnetic stimulation is well established in the treatment of major depressive disorder, and the intermittent theta burst stimulation (iTBS) protocol is replacing conventional protocols because of noninferiority and reduced delivery time. However, iTBS has not been adequately studied in bipolar disorder and, therefore, its efficacy is uncertain. OBJECTIVE To determine whether iTBS to the left dorsolateral prefrontal cortex (LDLPFC) is safe and efficacious in the treatment of acute bipolar depression. DESIGN, SETTING, AND PARTICIPANTS This study was a double-blind, 4-week, randomized clinical trial of iTBS targeting the LDLPFC. Two Canadian academic centers recruited patients between 2016 and 2020. Adults with bipolar disorder type I or type II experiencing an acute major depressive episode were eligible if they had not benefited from a first-line treatment for acute bipolar depression recommended by the Canadian Network for Mood and Anxiety Treatments and were currently treated with a mood stabilizer, an atypical antipsychotic, or their combination. Seventy-one participants were assessed for eligibility, and 37 were randomized to daily sham iTBS or active iTBS using a random number sequence, stratified according to current pharmacotherapy. Data analysis was performed from April to September 2020. INTERVENTIONS Four weeks of daily active iTBS (120% resting motor threshold) or sham iTBS to the LDLPFC. Nonresponders were eligible for 4 weeks of open-label iTBS. MAIN OUTCOMES AND MEASURES The primary outcome was the change in score on the Montgomery-Asberg Depression Rating Scale from baseline to study end. Secondary outcomes included clinical response, remission, and treatment-emergent mania or hypomania. RESULTS The trial was terminated for futility after 37 participants (23 women [62%]; mean [SD] age, 43.86 [13.87] years; age range, 20-68 years) were randomized, 19 to sham iTBS and 18 to active iTBS. There were no significant differences in Montgomery-Asberg Depression Rating Scale score changes (least squares mean difference between groups, -1.36 [95% CI, -8.92 to 6.19; P = .91] in favor of sham iTBS), and rates of clinical response were low in both the double-blind phase (3 of 19 participants [15.8%] in the sham iTBS group and 3 of 18 participants [16.7%] in the active iTBS group) and open-label phase (5 of 21 participants [23.8%]). One active iTBS participant had a treatment emergent hypomania, and a second episode occurred during open-label treatment. CONCLUSIONS AND RELEVANCE iTBS targeting the LDLPFC is not efficacious in the treatment of acute bipolar depression in patients receiving antimanic or mood stabilizing agents. Additional research is required to understand how transcranial magnetic stimulation treatment protocols differ in efficacy between unipolar and bipolar depression. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02749006.
Collapse
Affiliation(s)
- Alexander McGirr
- Department of Psychiatry, University of Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jaeden Cole
- Department of Psychiatry, University of Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada
| | - Ivan J. Torres
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- BC Mental Health and Substance Use Services, Vancouver, British Columbia, Canada
| | - Shyam Sundar Arumugham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India
| | - Kamyar Keramatian
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gayatri Saraf
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raymond W. Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lakshmi N. Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
27
|
Balachander S, Meier S, Matthiesen M, Ali F, Kannampuzha AJ, Bhattacharya M, Kumar Nadella R, Sreeraj VS, Ithal D, Holla B, Narayanaswamy JC, Arumugham SS, Jain S, Reddy YJ, Viswanath B. Are There Familial Patterns of Symptom Dimensions in Obsessive-Compulsive Disorder? Front Psychiatry 2021; 12:651196. [PMID: 33959055 PMCID: PMC8093508 DOI: 10.3389/fpsyt.2021.651196] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Obsessive-compulsive disorder (OCD) is a heterogeneous illness, and emerging evidence suggests that different symptom dimensions may have distinct underlying neurobiological mechanisms. We aimed to look for familial patterns in the occurrence of these symptom dimensions in a sample of families with at least two individuals affected with OCD. Methods: Data from 153 families (total number of individuals diagnosed with DSM-5 OCD = 330) recruited as part of the Accelerator Program for Discovery in Brain Disorders using Stem Cells (ADBS) was used for the current analysis. Multidimensional Item Response Theory (IRT) was used to extract dimensional scores from the Yale-Brown Obsessive-Compulsive Scale (YBOCS) checklist data. Using linear mixed-effects regression models, intra-class correlation coefficients (ICC), for each symptom dimension, and within each relationship type were estimated. Results: IRT yielded a four-factor solution with Factor 1 (Sexual/Religious/Aggressive), Factor 2 (Doubts/Checking), Factor 3 (Symmetry/Arranging), and Factor 4 (Contamination/Washing). All except for Factor 1 were found to have significant ICCs, highest for Factor 3 (0.41) followed by Factor 4 (0.29) and then Factor 2 (0.27). Sex-concordant dyads were found to have higher ICC values than discordant ones, for all the symptom dimensions. No major differences in the ICC values between parent-offspring and sib-pairs were seen. Conclusions: Our findings indicate that there is a high concordance of OCD symptom dimensions within multiplex families. Symptom dimensions of OCD might thus have significant heritability. In view of this, future genetic and neurobiological studies in OCD should include symptom dimensions as a key parameter in their analyses.
Collapse
Affiliation(s)
- Srinivas Balachander
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Bangalore, India.,Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - Sandra Meier
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Manuel Matthiesen
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,Department of Psychiatry Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany.,Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Furkhan Ali
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Bangalore, India.,Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - Anand Jose Kannampuzha
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Bangalore, India.,Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - Mahashweta Bhattacharya
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Bangalore, India.,Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - Ravi Kumar Nadella
- Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - Vanteemar S Sreeraj
- Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - Dhruva Ithal
- Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - Bharath Holla
- Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - Janardhanan C Narayanaswamy
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Bangalore, India.,Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - Shyam Sundar Arumugham
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Bangalore, India
| | - Sanjeev Jain
- Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - Yc Janardhan Reddy
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Bangalore, India.,Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - Biju Viswanath
- Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| |
Collapse
|
28
|
Syed FA, Naik SS, Arumugham SS, Mehta UM, Thirthalli J, Reddy YCJ. Adjuvant intermittent theta burst stimulation over dorsomedial prefrontal cortex in treatment-resistant obsessive-compulsive disorder type: Letter to the editor. Brain Stimul 2020; 14:74-76. [PMID: 33212242 DOI: 10.1016/j.brs.2020.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/20/2020] [Accepted: 11/11/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Farooq Ali Syed
- Department of Clinical Neurosciences, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Shalini S Naik
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| |
Collapse
|
29
|
Balachander S, Bajaj A, Hazari N, Kumar A, Anand N, Manjula M, Sudhir PM, Cherian AV, Narayanaswamy JC, Jaisoorya TS, Math SB, Kandavel T, Arumugham SS, Janardhan Reddy YC. Long-term Outcomes of Intensive Inpatient Care for Severe, Resistant Obsessive-Compulsive Disorder: Résultats à long terme de soins intensifs à des patients hospitalisés pour un trouble obsessionnel-compulsif grave et résistant. Can J Psychiatry 2020; 65:779-789. [PMID: 32452212 PMCID: PMC7564695 DOI: 10.1177/0706743720927830] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE A substantial proportion of severely ill patients with obsessive-compulsive disorder (OCD) do not respond to serotonin reuptake inhibitors (SRIs) and are unable to practice cognitive behavioral therapy (CBT) on an out-patient basis. We report the short-term (at discharge) and long-term (up to 2 years) outcome of a multimodal inpatient treatment program that included therapist-assisted intensive CBT with adjunctive pharmacotherapy for severely ill OCD patients who are often resistant to SRIs and are either unresponsive or unable to practice outpatient CBT. METHODS A total of 420 patients, admitted between January 2012 and December 2017 were eligible for the analysis. They were evaluated using the Mini International Neuropsychiatric Interview, the Yale-Brown Obsessive Compulsive Scale (YBOCS), and the Clinical Global Impression (CGI) scale. All patients received 4 to 5 therapist-assisted CBT sessions per week along with standard pharmacotherapy. Naturalistic follow-up information at 3, 6, 12, and 24 months were recorded. RESULTS At baseline, patients were mostly severely ill (YBOCS = 29.9 ± 4.5) and nonresponsive to ≥2 SRIs (83%). Mean duration of inpatient stay was 42.7 ± 25.3 days. At discharge, there was a significant decline in the mean YBOCS score (29.9 ± 4.5 vs. 18.1 ± 7.7, P < .001, Cohen's d = 1.64); 211/420 (50%) were responders (≥35% YBOCS reduction and CGI-I≤2) and an additional 86/420 (21%) were partial responders (25% to 35% YBOCS reduction and CGI-I≤3). Using latent class growth modeling of the follow-up data, 4 distinct classes were identified, which include "remitters" (14.5%), "responders" (36.5%), "minimal responders" (34.7%), and "nonresponders" (14.6%). Shorter duration of illness, better insight, and lesser contamination/washing symptoms predicted better response in both short- and long-term follow-up. CONCLUSION Intensive, inpatient-based care for OCD may be an effective option for patients with severe OCD and should be considered routinely in those who do not respond with outpatient treatment.
Collapse
Affiliation(s)
- Srinivas Balachander
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, 29148National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India
| | - Aakash Bajaj
- Department of Biostatistics, 29148NIMHANS, Bangalore, India
| | - Nandita Hazari
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, 29148National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India
| | - Ajay Kumar
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, 29148National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India.,Department of Clinical Psychology, 29148NIMHANS, Bangalore, India
| | - Nitin Anand
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, 29148National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India.,Department of Clinical Psychology, 29148NIMHANS, Bangalore, India
| | - M Manjula
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, 29148National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India.,Department of Clinical Psychology, 29148NIMHANS, Bangalore, India
| | - Paulomi M Sudhir
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, 29148National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India.,Department of Clinical Psychology, 29148NIMHANS, Bangalore, India
| | - Anish V Cherian
- Department of Psychiatric Social Work, 29148NIMHANS, Bangalore, India
| | - Janardhanan C Narayanaswamy
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, 29148National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India
| | - T S Jaisoorya
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, 29148National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India
| | - Suresh Bada Math
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, 29148National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India
| | | | - Shyam Sundar Arumugham
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, 29148National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India
| | - Y C Janardhan Reddy
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, 29148National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India
| |
Collapse
|
30
|
Sharma RK, Kulkarni G, Kumar CN, Arumugham SS, Sudhir V, Mehta UM, Mitra S, Thanki MV, Thirthalli J. Antidepressant effects of ketamine and ECT: A pilot comparison. J Affect Disord 2020; 276:260-266. [PMID: 32697707 DOI: 10.1016/j.jad.2020.07.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/26/2020] [Revised: 06/10/2020] [Accepted: 07/05/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND To compare the antidepressant effects and cognitive adverse effects of intravenous ketamine infusion and Electro-convulsive therapy (ECT) in persons with severe depressive episodes. METHODS This assessor-blinded randomized control trial included 25 patients (either sex; 18-65 years) meeting ICD-10 criteria for severe depression (bipolar or unipolar). Patients received either ECT (n = 13) or intravenous infusions of ketamine hydrochloride (0.5 mg/kg over 45 min; n = 12) for six alternate day sessions over a period of two weeks. Severity of depression was assessed at baseline and on every alternate day of intervention using the Hamilton Depression Rating Scale (HDRS) and self-reported Beck Depression Inventory (BDI). RESULTS Baseline socio-demographic and clinical variables including HDRS (ECT: 25.15±6.58; Ketamine: 23.33±4.05, p = 0.418) and BDI (ECT: 37.07±6.58; Ketamine: 33.33±9.29; p = 0.254) were comparable. Repeated-measures analysis of variance revealed that ECT patients showed significantly greater reduction in HDRS (group*time interaction effect; F = 4.79; p<0.001) and BDI scores (group*time interaction effect; F = 3.83; p<0.01). ECT patients had higher response rate than ketamine patients [HDRS: ECT- 13/13(100%) vs ketamine- 8/12 (66.70%); p = 0.04]. This was true for remission as well [ECT- 12/13(92.30%) vs ketamine- 6/12(50%), p = 0.030; both HDRS and BDI]. Performance on Digit Symbol Substitution Test (as part of the Battery for ECT-Related Cognitive Deficits scale) significantly improved in ketamine patients (p = 0.02) while that in ECT patients worsened non significantly (p = 0.30). LIMITATIONS Relatively small sample size; higher proportion of dropouts in the Ketamine arm. CONCLUSION This study favoured ECT over ketamine for a better efficacy over six treatment sessions in severe depression. The results need to be replicated in larger studies. TRIAL REGISTRATION CTRI/2019/09/021184.
Collapse
Affiliation(s)
- Ravi K Sharma
- Department of Psychiatry, Trivanta Medical and Neuro-psychiatry Hospital and Research Center, Udaipur, Rajasthan 313001, India.
| | - Gajanan Kulkarni
- Department of Psychiatry, Magna Centers for Obesity, Diabetes and Endocrinology, Bangalore, Karnataka 560076, India.
| | | | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 60029, India.
| | - Venkataramaiah Sudhir
- Department of Neuro-anaesthesia, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India.
| | - Urvakhsh M Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 60029, India.
| | - Sayantanava Mitra
- Queensland Health and Faculty of Medicine, University of Queensland Rural Medical School, Rockhampton, Queensland 4700, Australia.
| | - Milind Vijay Thanki
- Hertfordshire Partnership University, NHS Foundation Trust, Hatfeild, Hertfordshire, AL108YE England United Kingdom.
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 60029, India.
| |
Collapse
|
31
|
Shrinivasa B, Cherian AV, Arumugham SS, Philip BV, Pandian DR, Math SB, Reddy YCJ. Predictors of family accommodation in obsessive compulsive disorder. Asian J Psychiatr 2020; 53:102189. [PMID: 32535480 DOI: 10.1016/j.ajp.2020.102189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/02/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 12/22/2022]
Abstract
Family accommodation (FA) has been consistently recognized as a predictor of treatment outcome in obsessive-compulsive disorder (OCD). However, the factors determining FA are not clearly understood, especially in adult patients with OCD. We recruited a consecutive sample of predominantly adult subjects (n=100), who presented to the specialty OCD Clinic with a primary diagnosis of OCD along with a suitable caregiver. Patient and family members completed measurements assessing FA along with other clinical variables of interest. Clinical variables found statistically significant in bivariate analyses (p < 0.05) were examined in multivariate linear regression analysis to determine the predictors of FA. Age, gender and marital status of the patient, contamination symptom dimension, severity of avoidance, severity scores on Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and scores on work and social adjustment scale were associated with FA in bivariate analysis. In multiple regression analysis, contamination dimension, the severity of avoidance, relationship of caregiver and poorer work and social adjustment predicted FA. Patients with poor socio-occupational functioning, severe avoidance, caregiver being spouse and contamination related symptoms are accommodated more by family members. Screening and management of FA, particularly in patients with the contamination dimension may thus help improve treatment outcome.
Collapse
Affiliation(s)
- Basavaraj Shrinivasa
- Department of Psychiatric Social Work and OCD Specialty Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Anish V Cherian
- Department of Psychiatric Social Work and OCD Specialty Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India.
| | - Shyam Sundar Arumugham
- Department of Psychiatry and OCD Specialty Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Bibin V Philip
- Department of Psychiatric Social Work and OCD Specialty Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Dhanasekara R Pandian
- Department of Psychiatric Social Work and OCD Specialty Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry and OCD Specialty Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Y C Janardhan Reddy
- Department of Psychiatry and OCD Specialty Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| |
Collapse
|
32
|
Baliga SP, Mehta UM, Naik SS, Thanki MV, Mitra S, Arumugham SS, Kesavan M, Thirthalli J. A chart-based study of theta burst stimulation for depression at a tertiary care center. Brain Stimul 2020; 13:1606-1608. [PMID: 32987174 DOI: 10.1016/j.brs.2020.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/03/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Sachin Pradeep Baliga
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India.
| | - Shalini S Naik
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Milind Vijay Thanki
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Sayantanava Mitra
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Muralidharan Kesavan
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| |
Collapse
|
33
|
Jaisoorya TS, Thamby A, Manoj L, Kumar GS, Gokul GR, Narayanaswamy JC, Arumugham SS, Thennarassu K, Reddy YCJ. Prevalence of hoarding disorder among primary care patients. Braz J Psychiatry 2020; 43:168-173. [PMID: 32876135 PMCID: PMC8023159 DOI: 10.1590/1516-4446-2020-0846] [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] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/22/2020] [Indexed: 11/22/2022]
Abstract
Objectives: Despite the inclusion of hoarding disorder (HD) in the DSM-5, there is little epidemiological data on hoarding from low and middle-income countries. This study, the first from India, examines the prevalence and correlates of HD among primary care patients in the state of Kerala, India. Methods: To assess correlates, the Hoarding Rating Scale-Interview (HRS-I) and other structured instruments were administered to 7,555 subjects selected by stratified random sampling from 71 primary health centers. Results: The prevalence of HD was 1.02% (95%CI 0.8-1.3). Those with HD were more likely to be older and live alone. In the binary logistic regression analysis, after controlling for significant sociodemographic variables, subjects with HD had a higher odds of reporting chronic illness, depression, anxiety disorder, alcohol abuse, and tobacco dependence. Subjects with HD had significantly higher disability scores than unaffected individuals. Conclusion: Although HD is not uncommon in India, this disorder is rarely reported in specialty settings in India, which suggests that awareness and detection should be improved, considering the co-occurring negative correlates and disability among affected individuals.
Collapse
Affiliation(s)
- T S Jaisoorya
- National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Abel Thamby
- National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - L Manoj
- National Health Mission (NHM), Thiruvananthapuram, Kerala, India
| | - G Sunil Kumar
- National Health Mission (NHM), Thiruvananthapuram, Kerala, India
| | - G R Gokul
- National Health Mission (NHM), Thiruvananthapuram, Kerala, India
| | | | - Shyam Sundar Arumugham
- National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - K Thennarassu
- National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Y C Janardhan Reddy
- National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bengaluru, Karnataka, India
| |
Collapse
|
34
|
Nanjundaswamy MH, Arumugham SS, Narayanaswamy JC, Reddy YCJ. A prospective study of intensive in-patient treatment for obsessive-compulsive disorder. Psychiatry Res 2020; 291:113303. [PMID: 32763556 DOI: 10.1016/j.psychres.2020.113303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/23/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 11/30/2022]
Abstract
Multimodal in-patient treatment incorporating intensive cognitive-behaviour therapy (CBT) and medication management is a promising alternative for obsessive-compulsive disorder (OCD) patients who do not respond to standard out-patient treatment. We prospectively examined the short-term outcome and predictors of outcome of intensive in-patient treatment in a largely pharmacotherapy-resistant OCD sample. Fifty eight consecutive patients, admitted for treatment of OCD were evaluated at admission, at discharge and 2 months post-discharge for psychiatric diagnosis, personality disorders, obsessive beliefs, insight into obsessions and severity of obsessive-compulsive, depressive and anxiety symptoms. All patients received comprehensive treatment consisting of a combination of pharmacotherapy and intensive CBT. The mean Y-BOCS score was 29.38(±5.72) at admission, which reduced to 16.62(±7.91) at discharge and 16.75(±8.85) at follow-up. Thirty five participants (60.3%) met the prespecified criteria for response and 19 (32.8%) for remission. There was a significant reduction in Y-BOCS scores at discharge [43.67 (23.81)%] and post-discharge follow-up [2.18 (29.32)%] as compared to baseline (p<0.01). Baseline Browns Assessment of Beleifs Scale score (insight) was the only variable that statistically differentiated responders and non-responders. In-patient treatment is an effective treatment for medication resistant, severe and chronic OCD. Poor insight is a potential predictor of non-response to in-patient treatment.
Collapse
Affiliation(s)
- Madhuri H Nanjundaswamy
- Department of Psychiatry National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India 560029
| | - Shyam Sundar Arumugham
- Department of Psychiatry National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India 560029.
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India 560029
| | - Y C Janardhan Reddy
- Department of Psychiatry National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India 560029
| |
Collapse
|
35
|
Sharma LP, Thamby A, Balachander S, Janardhanan CN, Jaisoorya TS, Arumugham SS, Reddy YCJ. Clinical utility of repeated intravenous ketamine treatment for resistant obsessive-compulsive disorder. Asian J Psychiatr 2020; 52:102183. [PMID: 32554207 DOI: 10.1016/j.ajp.2020.102183] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 04/11/2020] [Revised: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 11/17/2022]
Abstract
Glutamate modulators are used to treat OCD resistant to serotonin reuptake inhibitors (SRIs). Ketamine has shown some promise in treating OCD. Data on the use of ketamine in SRI-resistant OCD is limited, with no studies on the role of multiple ketamine infusions in this disorder. We report our experience of treating SRI- resistant OCD with multiple ketamine infusions. We reviewed the clinical charts of 14 adult inpatients with a diagnosis of SRI-resistant OCD and treated them with repeated ketamine infusions [mean (SD) = 5.4 (2.5)]. There was a significant reduction in the Yale-Brown Obsessive-Compulsive Scale (YBOCS) total score following intravenous ketamine infusions. One patient showed a dramatic response (a drop in the YBOCS to '0') and two patients showed a partial response (25-35 % reduction in the YBOCS). Eleven patients showed no clinical improvement. Ketamine may, therefore, be somewhat effective in a subset of OCD patients who are resistant to SRIs. Our findings suggest the need to examine the efficacy of ketamine in controlled studies with larger samples. It may be possible to identify predictors of response to ketamine in larger studies.
Collapse
Affiliation(s)
- Lavanya P Sharma
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Hosur Road, Bangalore, India
| | - Abel Thamby
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Hosur Road, Bangalore, India
| | - Srinivas Balachander
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Hosur Road, Bangalore, India
| | - C Narayanaswamy Janardhanan
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Hosur Road, Bangalore, India
| | - T S Jaisoorya
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Hosur Road, Bangalore, India
| | - Shyam Sundar Arumugham
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Hosur Road, Bangalore, India
| | - Y C Janardhan Reddy
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Hosur Road, Bangalore, India.
| |
Collapse
|
36
|
Fineberg NA, Hollander E, Pallanti S, Walitza S, Grünblatt E, Dell’Osso BM, Albert U, Geller DA, Brakoulias V, Janardhan Reddy Y, Arumugham SS, Shavitt RG, Drummond L, Grancini B, De Carlo V, Cinosi E, Chamberlain SR, Ioannidis K, Rodriguez CI, Garg K, Castle D, Van Ameringen M, Stein DJ, Carmi L, Zohar J, Menchon JM. Clinical advances in obsessive-compulsive disorder: a position statement by the International College of Obsessive-Compulsive Spectrum Disorders. Int Clin Psychopharmacol 2020; 35:173-193. [PMID: 32433254 PMCID: PMC7255490 DOI: 10.1097/yic.0000000000000314] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/16/2020] [Indexed: 11/25/2022]
Abstract
In this position statement, developed by The International College of Obsessive-Compulsive Spectrum Disorders, a group of international experts responds to recent developments in the evidence-based management of obsessive-compulsive disorder (OCD). The article presents those selected therapeutic advances judged to be of utmost relevance to the treatment of OCD, based on new and emerging evidence from clinical and translational science. Areas covered include refinement in the methods of clinical assessment, the importance of early intervention based on new staging models and the need to provide sustained well-being involving effective relapse prevention. The relative benefits of psychological, pharmacological and somatic treatments are reviewed and novel treatment strategies for difficult to treat OCD, including neurostimulation, as well as new areas for research such as problematic internet use, novel digital interventions, immunological therapies, pharmacogenetics and novel forms of psychotherapy are discussed.
Collapse
Affiliation(s)
- Naomi A. Fineberg
- University of Hertfordshire, Hatfield
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Eric Hollander
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Stefano Pallanti
- Istituto di Neuroscienze, University of Florence, Firenze, Italy
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich
- Neuroscience Center Zurich, University of Zurich and ETH Zurich
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Edna Grünblatt
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich
- Neuroscience Center Zurich, University of Zurich and ETH Zurich
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Bernardo Maria Dell’Osso
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Ospedale Sacco-Polo Universitario, ASST Fatebenefratelli-Sacco, Milan, Italy
- Department of Psychiatry and Behavioural Sciences, Stanford University, California, USA
- CRC ‘Aldo Ravelli’ for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, UCO Clinica Psichiatrica, University of Trieste, Trieste, Italy
| | - Daniel A. Geller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Vlasios Brakoulias
- Western Sydney Obsessive-Compulsive and Related Disorders Service, Western Sydney Local Health District, Blacktown Hospital, Blacktown, New South Wales
- Translational Research Health Institute (THRI), Clinical and Health Psychology Research Initiative (CaHPRI) and School of Medicine, Western Sydney University, Sydney, Australia
| | - Y.C. Janardhan Reddy
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Shyam Sundar Arumugham
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Roseli G. Shavitt
- OCD Spectrum Disorders Program, Institute and Department of Psychiatry, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo-SP, Brazil
| | - Lynne Drummond
- Consultant Psychiatrist, SW London and St George’s NHS Trust and St George’s, University of London, London
| | - Benedetta Grancini
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Ospedale Sacco-Polo Universitario, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Vera De Carlo
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Ospedale Sacco-Polo Universitario, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Eduardo Cinosi
- University of Hertfordshire, Hatfield
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire
| | - Samuel R. Chamberlain
- Department of Psychiatry, University of Cambridge, Cambridge
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Konstantinos Ioannidis
- Department of Psychiatry, University of Cambridge, Cambridge
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Carolyn I. Rodriguez
- Department of Psychiatry and Behavioural Sciences, Stanford University, California, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Kabir Garg
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire
| | - David Castle
- St. Vincent’s Hospital Melbourne and The University of Melbourne, Melbourne, Australia
| | - Michael Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Dan J. Stein
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Lior Carmi
- The Post Trauma Center, Chaim Sheba Medical Center, Ramat Gan
- The Data Science Institution, The Interdisciplinary Center, Herzliya
| | - Joseph Zohar
- The Post Trauma Center, Chaim Sheba Medical Center, Ramat Gan
- Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Jose M. Menchon
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, University of Barcelona, Cibersam, Barcelona, Spain
| |
Collapse
|
37
|
Lenka A, Ingalhalikar M, Shah A, Saini J, Arumugham SS, Hegde S, George L, Yadav R, Pal PK. Abnormalities in the white matter tracts in patients with Parkinson disease and psychosis. Neurology 2020; 94:e1876-e1884. [PMID: 32317347 DOI: 10.1212/wnl.0000000000009363] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/15/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE The objective of the current study was to compare the microstructural integrity of the white matter (WM) tracts in patients having Parkinson disease (PD) with and without psychosis (PD-P and PD-NP) through diffusion tensor imaging (DTI). METHODS This cross-sectional study involved 48 PD-NP and 42 PD-P who were matched for age, sex, and education. Tract-based spatial statistics (TBSS) was used to compare several DTI metrics from the diffusion-weighted MRIs obtained through a 3-Tesla scanner. A set of neuropsychological tests was used for the cognitive evaluation of all patients. RESULTS The severity and stage of PD were not statistically different between the groups. The PD-P group performed poorly in all the neuropsychological domains compared with the PD-NP group. TBSS analysis revealed widespread patterns of abnormality in the fractional anisotropy (FA) in the PD-P group, which also correlated with some of the cognitive scores. These tracts include inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, right parieto-occipital WM, body of the corpus callosum, and corticospinal tract. CONCLUSION This study provides novel insights into the putative role of WM tract abnormalities in the pathogenesis of PD-P by demonstrating significant alterations in several WM tracts. Additional longitudinal studies are warranted to confirm the findings of our research.
Collapse
Affiliation(s)
- Abhishek Lenka
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Madhura Ingalhalikar
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Apurva Shah
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Jitender Saini
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Shyam Sundar Arumugham
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Shantala Hegde
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Lija George
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Ravi Yadav
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Pramod Kumar Pal
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC.
| |
Collapse
|
38
|
Affiliation(s)
- Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences (NIMHANS) , Bangalore, India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences (NIMHANS) , Bangalore, India
| |
Collapse
|
39
|
Reddy YCJ, Sudhir PM, Manjula M, Arumugham SS, Narayanaswamy JC. Clinical Practice Guidelines for Cognitive-Behavioral Therapies in Anxiety Disorders and Obsessive-Compulsive and Related Disorders. Indian J Psychiatry 2020; 62:S230-S250. [PMID: 32055066 PMCID: PMC7001348 DOI: 10.4103/psychiatry.indianjpsychiatry_773_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/16/2019] [Indexed: 12/05/2022] Open
Affiliation(s)
- Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Paulomi M Sudhir
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - M Manjula
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| |
Collapse
|
40
|
Nanjundaswamy MH, Varshney P, Thanki MV, Arunya B, Rai V, Mehta UM, Arumugham SS, Sudhir PM, Chandra PS. Theta burst stimulation for tokophobia during pregnancy. Brain Stimul 2019; 12:1322-1324. [DOI: 10.1016/j.brs.2019.06.018] [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] [Received: 04/29/2019] [Revised: 06/05/2019] [Accepted: 06/14/2019] [Indexed: 10/26/2022] Open
|
41
|
Mehta UM, Thanki MV, Mitra S, Arumugham SS, Thirthalli J. Will theta burst the TMS depression clinical bubble? Asian J Psychiatr 2019; 40:24-25. [PMID: 30711883 DOI: 10.1016/j.ajp.2019.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 01/17/2019] [Accepted: 01/24/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India.
| | - Milind Vijay Thanki
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India
| | - Sayantanava Mitra
- Faculty of Medicine, The University of Queensland Rural Clinical School, Rockhapmton, QLD, Australia
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India
| |
Collapse
|
42
|
Bagewadi VI, Mehta UM, Naik SS, Govindaraj R, Varambally S, Arumugham SS, Naveen Kumar C, Thirthalli J. Diminished modulation of motor cortical reactivity during context-based action observation in schizophrenia. Schizophr Res 2019; 204:222-229. [PMID: 30093350 PMCID: PMC7610505 DOI: 10.1016/j.schres.2018.07.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 04/12/2018] [Revised: 07/25/2018] [Accepted: 07/28/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Deficient mirror neuron system (MNS)-activity is associated with social cognition deficits in schizophrenia. However, it is not known how socio-emotional contexts modulate the MNS-response. In a Transcranial Magnetic Stimulation (TMS)-experiment, we aimed to compare putative MNS-responses to action observation stimuli with and without a context, in patients with schizophrenia and healthy subjects. METHOD TMS-evoked motor cortical reactivity was measured by single and paired [short interval intracortical inhibition (SICI) and facilitation (ICF)] pulse-paradigms in schizophrenia patients (n = 39) and healthy subjects (n = 28) while they observed three experimental-blocks: a static image, a neutral hand action (NA) and a context-based hand action (CA). The degree of cortical reactivity facilitation with the two action observation blocks, relative to the static block provided indirect measures of premotor MNS-activity. A subset of patients (n = 31) also underwent comprehensive social cognition assessments. RESULTS RMANOVA demonstrated significantly higher cortical reactivity during the CA-block in both groups (all TMS-paradigms); albeit significantly less pronounced in patients (SICI and ICF paradigms). MNS-activity during the CA-block was significantly higher compared to that during the NA-block in both groups (all TMS-paradigms), but significantly less pronounced in patients (SICI and single-pulse paradigms). MNS-activity during the CA-block measured by the ICF paradigm was positively correlated with social cognition performance. CONCLUSION Providing a context to the action modulates MNS-activity. This modulation is diminished in schizophrenia patients, suggestive of a diminished sensorimotor associative learning process. This novel, ecologically valid paradigm to tap into the MNS may serve as a neuro-marker of social cognition performance in schizophrenia.
Collapse
Affiliation(s)
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, Karnataka, India.
| | | | | | | | | | | | | |
Collapse
|
43
|
Narayanaswamy JC, Arumugham SS, Jaisoorya TS, Reddy YCJ. Recent advances in obsessive compulsive and related disorders. Indian J Psychiatry 2019; 61:S2-S3. [PMID: 30745671 PMCID: PMC6343412 DOI: 10.4103/psychiatry.indianjpsychiatry_587_18] [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: 11/25/2022] Open
Affiliation(s)
| | | | - T S Jaisoorya
- Consultants, OCD Clinic, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Y C Janardhan Reddy
- Consultants, OCD Clinic, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| |
Collapse
|
44
|
Brakoulias V, Starcevic V, Albert U, Arumugham SS, Bailey BE, Belloch A, Borda T, Dell'Osso L, Elias JA, Falkenstein MJ, Ferrao YA, Fontenelle LF, Jelinek L, Kalogeraki L, Kay B, Laurito LD, Lochner C, Maina G, Marazziti D, Martin A, Matsunaga H, Miguel EC, Morgado P, Mourikis I, Pasquini M, Perez Rivera R, Potluri S, Reddy JYC, Riemann BC, do Rosario MC, Shavitt RG, Stein DJ, Viswasam K, Wang Z, Fineberg NA. Treatments used for obsessive-compulsive disorder-An international perspective. Hum Psychopharmacol 2019; 34:e2686. [PMID: 30628745 DOI: 10.1002/hup.2686] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 09/11/2018] [Revised: 12/05/2018] [Accepted: 12/11/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The objective of this study was to characterise international trends in the use of psychotropic medication, psychological therapies, and novel therapies used to treat obsessive-compulsive disorder (OCD). METHODS Researchers in the field of OCD were invited to contribute summary statistics on the characteristics of their samples. Consistency of summary statistics across countries was evaluated. RESULTS The study surveyed 19 expert centres from 15 countries (Argentina, Australia, Brazil, China, Germany, Greece, India, Italy, Japan, Mexico, Portugal, South Africa, Spain, the United Kingdom, and the United States) providing a total sample of 7,340 participants. Fluoxetine (n = 972; 13.2%) and fluvoxamine (n = 913; 12.4%) were the most commonly used selective serotonin reuptake inhibitor medications. Risperidone (n = 428; 7.3%) and aripiprazole (n = 415; 7.1%) were the most commonly used antipsychotic agents. Neurostimulation techniques such as transcranial magnetic stimulation, deep brain stimulation, gamma knife surgery, and psychosurgery were used in less than 1% of the sample. There was significant variation in the use and accessibility of exposure and response prevention for OCD. CONCLUSIONS The variation between countries in treatments used for OCD needs further evaluation. Exposure and response prevention is not used as frequently as guidelines suggest and appears difficult to access in most countries. Updated treatment guidelines are recommended.
Collapse
Affiliation(s)
- Vlasios Brakoulias
- Department of Psychiatry, Nepean Hospital, Sydney Medical School, The University of Sydney, Penrith, NSW, Australia
| | - Vladan Starcevic
- Department of Psychiatry, Nepean Hospital, Sydney Medical School, The University of Sydney, Penrith, NSW, Australia
| | - Umberto Albert
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy.,Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Brenda E Bailey
- Department of Psychiatry, Rogers Memorial Hospital, Oconomowoc, Wisconsin
| | - Amparo Belloch
- Department of Personality Psychology, Research Unit for Obsessive-Compulsive and Related Disorders, I'TOC, Faculty of Psychology, Universidad de Valencia, Valencia, Spain
| | - Tania Borda
- Department of Psychiatry, Bio-Behavioral Institute BA, Buenos Aires, Argentina.,Department of Psychology, Argentinian Catholic University (UCA), Buenos Aires, Argentina
| | - Liliana Dell'Osso
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, Dipartmento di Farmacia, University of Pisa, Pisa, Italy
| | - Jason A Elias
- Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Martha J Falkenstein
- Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Ygor A Ferrao
- Department of Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Leonardo F Fontenelle
- Department of Psychiatry and Legal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Psychiatry, D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria
| | - Lena Jelinek
- Department of Psychology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Leto Kalogeraki
- Behavioral Therapy Department/Outpatient Clinic for OCD and Related Disorders, Division of Psychiatry I, National and Kapodistrian University of Athens, Athens, Greece
| | - Brian Kay
- Department of Psychiatry, Rogers Memorial Hospital, Oconomowoc, Wisconsin
| | - Luana D Laurito
- Department of Psychiatry and Legal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Psychiatry, D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria
| | - Christine Lochner
- MRC Unit on Anxiety Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | - Giuseppe Maina
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Donatella Marazziti
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, Dipartmento di Farmacia, University of Pisa, Pisa, Italy
| | - Andrew Martin
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Hisato Matsunaga
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Euripedes C Miguel
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Pedro Morgado
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,Department of Psychiatry, ICVS-3Bs-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Department of Psychiatry, Hospital de Braga, Braga, Portugal
| | - Irakis Mourikis
- Behavioral Therapy Department/Outpatient Clinic for OCD and Related Disorders, Division of Psychiatry I, National and Kapodistrian University of Athens, Athens, Greece
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Sriramya Potluri
- Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Janardhan Y C Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Brian C Riemann
- Department of Psychiatry, Rogers Memorial Hospital, Oconomowoc, Wisconsin
| | | | - Roseli G Shavitt
- Department of Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Dan J Stein
- MRC Unit on Anxiety Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | - Kirupumani Viswasam
- Department of Psychiatry, Nepean Hospital, Sydney Medical School, The University of Sydney, Penrith, NSW, Australia
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Psychiatry, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Naomi A Fineberg
- Department of Psychiatry, Hertfordshire Partnership University NHS Foundation Trust and University of Hertfordshire, Hatfield, UK
| |
Collapse
|
45
|
Abstract
Despite advancements in pharmacotherapeutic and behavioral interventions, a substantial proportion of patients with obsessive-compulsive disorder (OCD) continue to have disabling and treatment-refractory illness. Neurosurgical interventions, including ablative procedures and deep brain stimulation (DBS), have emerged as potential treatment options in this population. We review the recent literature on contemporary surgical options for OCD, focusing on clinical aspects such as patient selection, presurgical assessment, and safety and effectiveness of these procedures. Given the invasiveness and limited evidence, these procedures have been performed in carefully selected patients with severe, chronic, and treatment-refractory illness. Along with informed consent, an independent review by a multidisciplinary team is mandated in many centers. Both ablative procedures and DBS have been found to be helpful in around half the patients, with improvement observed months after the procedure. Various targets have been proposed for either procedure, based on the dominant corticostriatal model of OCD. There is no strong evidence to recommend one procedure over the other. Hence, the choice of procedure is often based on the factors such as affordability, expertise, and reversibility of adverse effects. Surgery is not recommended as a standalone treatment but should be provided as part of a comprehensive package including medications and psychotherapeutic interventions. Available evidence suggest that the benefits of the procedure outweigh the risks in a treatment-refractory population. Advances in neurosurgical techniques and increasing knowledge of neurobiology are likely to bring about further progress in the efficacy, safety, and acceptability of the procedures.
Collapse
Affiliation(s)
- Srinivas Balachander
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| |
Collapse
|
46
|
Kulkarni KR, Reddy PV, Purty A, Arumugham SS, Muralidharan K, Reddy YJ, Yatham L, Jain S. Course and naturalistic treatment seeking among persons with first episode mania in India: A retrospective chart review with up to five years follow-up. J Affect Disord 2018; 240:183-186. [PMID: 30075389 DOI: 10.1016/j.jad.2018.07.039] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/31/2018] [Accepted: 07/14/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND An understanding of the early course of Bipolar Disorder (BD) can contribute towards developing timely interventions. First episode mania (FEM) determines a diagnosis of bipolarity, and therefore, onset of BD-I. We investigated the course of BD-I over a five-year period after FEM by retrospective chart review. METHODS Charts of patients diagnosed with FEM in 2008 (n = 108) were reviewed. Data was extracted about FEM and subsequent course up to 5 years, for those who came for follow-up during this period. The factors influencing course were evaluated with statistical analyses including logistic regression and survival analysis. RESULTS The mean age at onset of BD was 26 ± 9.2 years and mean age at FEM was 27.1 ± 9 years. 41 (38%) patients had previous depression. Patients who returned for at least one follow-up were 60/108 (55.6%), with 54 (90%) of them experiencing another mood episode following FEM. Most recurrences occurred between 6 months to 1 year after FEM, with manic episodes occurring two-three times as frequently as depressive episodes. Good adherence to treatment was a predictor of fewer hospitalizations [B = -0.61; t = -3.1; p = 0.004]. LIMITATIONS The study was limited by its retrospective design and high number of dropouts. CONCLUSION The five-year course after FEM showed twice the number of manic compared to depressive recurrences, irrespective of when the recurrence occurred. Consistent with earlier reports from India, BD-I appears to be mania-predominant, even early in the course. This has significant implications in planning maintenance treatments.
Collapse
Affiliation(s)
- Karishma R Kulkarni
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore 560029, Karnataka, India
| | - Preethi V Reddy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore 560029, Karnataka, India
| | - Abhishek Purty
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore 560029, Karnataka, India
| | - Shyam Sundar Arumugham
- 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.
| | - Yc Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore 560029, Karnataka, India
| | - Lakshmi Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 2A1, Canada
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore 560029, Karnataka, India
| |
Collapse
|
47
|
Thota N, Lenka A, George L, Hegde S, Arumugham SS, Prasad S, Stezin A, Kamble N, Yadav R, Pal PK. Impaired frontal lobe functions in patients with Parkinson's disease and psychosis. Asian J Psychiatr 2017; 30:192-195. [PMID: 29101795 DOI: 10.1016/j.ajp.2017.10.013] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 10/15/2017] [Accepted: 10/16/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Patients with Parkinson's disease (PD) may develop several non-motor symptoms (NMS). Psychosis is one of the debilitating NMS of PD. The neurobiology of psychosis is not fully understood. This study aims to compare the frontal lobe functions of PD patients with and without psychosis using the Frontal Assessment Battery (FAB). METHODOLOGY This study included 69 patients with PD; 34 with psychosis (PD-P) and 35 without psychosis (PD-NP). Mini Mental Status Examination (MMSE) was used to screen for cognitive impairment. Unified Parkinson's disease Rating scale part-III (UPDRS-III) was used to measure the severity and Hoehn and Yahr score (H&Y) was used to measure the stage of PD. Frontal lobe functions were assessed by FAB. RESULTS The PD-P and PD-NP groups were comparable for age (58.7±8.4 vs 55.7±8.2, p=0.14), age at onset of symptoms (51.4±8.1 vs 50.0±8.8, p=0.48), gender distribution (men: 88%vs 80%, p=0.51), MMSE (28.2±1.9 vs 28.7±1.2 p=0.12), levodopa equivalent dose/day (736.0±376.3 vs 625.2±332.2, p=0.19), UPDRS-III OFF-score (36.7±8.8 vs 35.4±13.2, p=0.64), UPDRS-III ON-score (13.2±5.4 vs 12.4±6.6, p=0.44) and H&Y stage (2.3±0.3 vs 2.3±0.3, p=0.07). PD-P group had lower total FAB score compared to PD-NP group (13.9±2.2 vs 16.5±1.8, p<0.01). On the FAB, PD-P group had lower scores compared to PD-NP in lexical fluency (FAB-2), programming (FAB-3), sensitivity to interference (FAB-4) and inhibitory control (FAB-5). CONCLUSION Patients with PD-P had significant frontal lobe dysfunction compared to PD-NP. FAB may be a simple and useful bedside tool to assess frontal dysfunction in patients with PD in a busy neurological set up.
Collapse
Affiliation(s)
- Naveen Thota
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Abhishek Lenka
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India; Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Lija George
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Shantala Hegde
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Shweta Prasad
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India; Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Albert Stezin
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India; Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
| |
Collapse
|
48
|
Arumugham SS, Torres IJ, Lang DJ, Su W, Lam RW, Honer WG, Yatham LN. Subcortical structural volumes in recently remitted first episode mania. J Affect Disord 2017; 222:23-27. [PMID: 28667890 DOI: 10.1016/j.jad.2017.06.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 03/30/2017] [Revised: 06/07/2017] [Accepted: 06/23/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) studies have yielded inconsistent findings with regard to subcortical volumetric abnormalities in patients with bipolar I disorder. Duration of illness and long term medication intake could have confounded the findings. METHOD Volumes of nine subcortical structures were compared between 63 patients who recently remitted from their first manic episode and 77 healthy volunteers. The volumetric segmentation was performed with the automated segmentation algorithm Freesurfer version 5.1. RESULTS There were no significant volumetric differences between the two groups in any of the structures examined including caudate, putamen, globus pallidum, nucleus accumbens, amygdala, thalamus, cerebellum, hippocampus and lateral ventricles (q > 0.05-false discovery rate corrected). LIMITATIONS All patients were on psychotropic medications at the time of scanning, which might have confounded the results. Sample size may not be large enough to detect small volumetric changes. CONCLUSIONS Patients with bipolar I disorder do not appear to have any significant subcortical volumetric abnormalities during the early stage of the disease. Thus, early stage bipolar disorder may present an opportunity for intervention to arrest neuroprogression of the disease.
Collapse
Affiliation(s)
| | - Ivan J Torres
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Wayne Su
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
49
|
Yatham LN, Sossi V, Ding YS, Vafai N, Arumugham SS, Dhanoa T, Lam RW, Bond DJ, Puyat JH. A Positron Emission Tomography Study of Norepinephrine Transporter Occupancy and Its Correlation with Symptom Response in Depressed Patients Treated with Quetiapine XR. Int J Neuropsychopharmacol 2017; 21:108-113. [PMID: 29016993 PMCID: PMC5793822 DOI: 10.1093/ijnp/pyx066] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Quetiapine is effective in treating depressive symptoms in major depressive disorder and bipolar disorder, but the mechanisms underlying its antidepressants effects are unknown. Norquetiapine, a metabolite of quetiapine, has high affinity for norepinephrine transporter, which might account for its therapeutic efficacy. METHODS In this study, we used positron emission tomography with (S,S)-[11C]O-methyl reboxetine to estimate norepinephrine transporter density and assess the relationship between norepinephrine transporter occupancy by quetiapine XR and improvement in depression in patients with major depressive disorder (n=5) and bipolar disorder (n=5). After the baseline positron emission tomography scan, patients were treated with quetiapine XR with a target dose of 150 mg in major depressive disorder and 300 mg in bipolar disorder. Patients had a second positron emission tomography scan at the end of week 2 and a final scan at week 7. RESULTS Norepinephrine transporter density was significantly lower in locus ceruleus in patients compared with healthy subjects. Further, there was a significant positive correlation between quetiapine XR dose and norepinephrine transporter occupancy in locus ceruleus at week 2. The norepinephrine transporter occupancy at week 2 in hypothalamus but not in other regions predicted improvement in depression as reflected by reduction in MADRS scores from baseline to week 7. The estimated dose of quetiapine XR associated with 50% norepinephrine transporter occupancy in hypothalamus at week 2 was 256 mg and the estimated plasma levels of norquetiapine to achieve 50% norepinephrine transporter occupancy was 36.8 µg/L. CONCLUSION These data provide preliminary support for the hypothesis that norepinephrine transporter occupancy by norquetiapine may be a contributor to the antidepressant effects of quetiapine.
Collapse
Affiliation(s)
- Lakshmi N Yatham
- Department of Psychiatry The University of British Columbia, Vancouver, British Columbia, Canada,Correspondence: Lakshmi N. Yatham, MBBS, Professor of Psychiatry, University of British Columbia, UBC Hospital, 2255 Wesbrook Mall, Vancouver, BC Canada, V6T 2A1 (
| | - Vesna Sossi
- TRIUMF Positron Emission Tomography Program , The University of British Columbia, Vancouver, British Columbia, Canada
| | - Yu-Shin Ding
- Departments of Radiology, Psychiatry and Chemistry, New York University School of Medicine, New York, New York
| | - Nasim Vafai
- TRIUMF Positron Emission Tomography Program , The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shyam Sundar Arumugham
- Department of Psychiatry The University of British Columbia, Vancouver, British Columbia, Canada
| | - Taj Dhanoa
- Department of Psychiatry The University of British Columbia, Vancouver, British Columbia, Canada
| | - Raymond W Lam
- Department of Psychiatry The University of British Columbia, Vancouver, British Columbia, Canada
| | - David J Bond
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Joseph H Puyat
- Center for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada
| |
Collapse
|
50
|
Hegde A, Kalyani BG, Arumugham SS, Narayanaswamy JC, Math SB, Reddy YCJ. Aripiprazole augmentation in highly treatment-resistant obsessive-compulsive disorder - experience from a specialty clinic in India. Int J Psychiatry Clin Pract 2017; 21:67-69. [PMID: 27629160 DOI: 10.1080/13651501.2016.1225098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To study the effectiveness and tolerability of aripiprazole augmentation in patients with highly treatment-resistant obsessive-compulsive disorder (OCD) in a real-world scenario. METHODS We conducted a chart review of patients who were initiated on aripiprazole augmentation at a specialty OCD clinic in India between 2004 and 2014. Primary outcome measure was all-cause discontinuation. RESULTS 23 patients were eligible for analysis. Patients had not achieved symptom remission despite a mean of over 3 prior SRI trials. Aripiprazole was continued to be used in seven patients (30%) at the time of last follow-up. Thirteen patients (57%) discontinued the drug due to side effects, and three patients (13%) discontinued aripiprazole citing no improvement. Six patients (26%) were noted to have ≥25% reduction on the Yale-Brown Obsessive-Compulsive Scale. CONCLUSIONS The study demonstrated, in a real-world setting, that aripiprazole may be a useful augmenting agent in a proportion of patients with highly treatment-resistant OCD. However, side effects may lead to premature discontinuation in many of them.
Collapse
Affiliation(s)
- Aditya Hegde
- a OCD Clinic, Department of Psychiatry , National Institute of Mental Health and Neurosciences (NIMHANS) , Bangalore , India
| | - Bangalore G Kalyani
- a OCD Clinic, Department of Psychiatry , National Institute of Mental Health and Neurosciences (NIMHANS) , Bangalore , India
| | - Shyam Sundar Arumugham
- a OCD Clinic, Department of Psychiatry , National Institute of Mental Health and Neurosciences (NIMHANS) , Bangalore , India
| | - Janardhanan C Narayanaswamy
- a OCD Clinic, Department of Psychiatry , National Institute of Mental Health and Neurosciences (NIMHANS) , Bangalore , India
| | - Suresh Bada Math
- a OCD Clinic, Department of Psychiatry , National Institute of Mental Health and Neurosciences (NIMHANS) , Bangalore , India
| | - Y C Janardhan Reddy
- a OCD Clinic, Department of Psychiatry , National Institute of Mental Health and Neurosciences (NIMHANS) , Bangalore , India
| |
Collapse
|