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Pathak H, Bagali K, Nayok SB, Nichenametla S, Shah V, Shroff M, Sreeraj VS, Venkatasubramanian G. Beyond conventional: Feasibility of accelerated tACS in clozapine-resistant schizophrenia - A case report. Asian J Psychiatr 2024; 95:104029. [PMID: 38547574 DOI: 10.1016/j.ajp.2024.104029] [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: 02/19/2024] [Revised: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 05/13/2024]
Affiliation(s)
- Harsh Pathak
- 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
| | - Swarna Buddha Nayok
- Department of Clinical Neurosciences, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Sonika Nichenametla
- 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
| | - Mitali Shroff
- 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.
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India; Department of Clinical Neurosciences, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
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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.
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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
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Ritish D, Reddy PV, Sreeraj VS, Chhabra H, Kumar V, Venkatasubramanian G, Muralidharan K. Oculomotor Abnormalities and Aberrant Neuro-Developmental Markers: Composite Endophenotype for Bipolar I Disorder: Anomalies Oculomotrices et Marqueurs Neuro-Développementaux Aberrants : Endophénotype Composite du Trouble Bipolaire I. Can J Psychiatry 2024:7067437241248048. [PMID: 38651336 DOI: 10.1177/07067437241248048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Neurological soft signs (NSSs), minor physical anomalies (MPAs), and oculomotor abnormalities were plausible biomarkers in bipolar disorder (BD). However, specific impairments in these markers in patients after the first episode mania (FEM), in comparison with first-degree relatives (high risk [HR]) of BD and healthy subjects (health control [HC]) are sparse. AIM OF THE STUDY This study aimed at examining NSSs, MPAs, and oculomotor abnormalities in remitted adult subjects following FEM and HR subjects in comparison with matched healthy controls. Investigated when taken together, could serve as composite endophenotype for BD. METHODS NSSs, MPAs, and oculomotor abnormalities were evaluated in FEM (n = 31), HR (n = 31), and HC (n = 30) subjects, matched for age (years) (p = 0.44) and sex (p = 0.70) using neurological evaluation scale, Waldrop's physical anomaly scale and eye tracking (SPEM) and antisaccades (AS) paradigms, respectively. RESULTS Significant differences were found between groups on NSSs, MPAs, and oculomotor parameters. Abnormalities are higher in FEM subjects compared to HR and HC subjects. Using linear discriminant analysis, all 3 markers combined accurately classified 72% of the original 82 subjects (79·2% BD, 56·70% HR, and 82·1% HC subjects). CONCLUSIONS AS and SPEM could enhance the utility of NSSs, and MPAs as markers for BD. The presence of these abnormalities in FEM suggests their role in understanding the etiopathogenesis of BD in patients who are in the early course of illness. These have the potential to be composite endophenotypes and have further utility in early identification in BD.
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Affiliation(s)
- Daniel Ritish
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Preethi V Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Harleen Chhabra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vijay Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Kesavan Muralidharan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
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Gangadhar BN, Sreeraj VS, Sinha P, Thirthalli J. Standards for medical devices: Electroconvulsive therapy machine. Asian J Psychiatr 2024; 93:103938. [PMID: 38335891 DOI: 10.1016/j.ajp.2024.103938] [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: 12/15/2023] [Accepted: 01/31/2024] [Indexed: 02/12/2024]
Abstract
The manuscript calls for establishing a standard for electroconvulsive devices by manufacturers for better regulation in India. This is most relevant in the context of two recent developments, (a) Notification of medical devices rules, 2017 with classification of ECT as Class C and (b) Recent change in classification of ECT devices by US-FDA in 2018. The establishment of standards would help in upregulating the standard of ECT devices as well as ECT practices.
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Affiliation(s)
- Bangalore N Gangadhar
- National Institute of Mental Health and NeuroSciences (NIMHANS), President, National Medical Commission, Pocket-14, Sector 8, Dwaraka Phase-1, New Delhi 110077, India
| | - Vanteemar S Sreeraj
- Clinical Research Centre for Neuromodulation in Psychiatry, Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru 560029, Karnataka, India
| | - Preeti Sinha
- Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru 560029, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru 560029, Karnataka, India.
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Uppinkudru C, Sreeraj VS, Arumugham SS, Praharaj SK, Goyal N, Sinha P, Thirthalli J. Is ECT better than clozapine for treatment-resistant schizophrenia? Asian J Psychiatr 2023; 90:103798. [PMID: 37871364 DOI: 10.1016/j.ajp.2023.103798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/17/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Chithra Uppinkudru
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Shyam Sunder Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Samir K Praharaj
- Department of Psychiatry, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India
| | | | - Preeti Sinha
- 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.
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Pathak H, Sreeraj VS, Venkatasubramanian G. Transcranial Alternating Current Stimulation (tACS) and Its Role in Schizophrenia: A Scoping Review. Clin Psychopharmacol Neurosci 2023; 21:634-649. [PMID: 37859437 PMCID: PMC10591171 DOI: 10.9758/cpn.22.1042] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/16/2023] [Accepted: 02/06/2023] [Indexed: 10/21/2023]
Abstract
Transcranial alternating current stimulation (tACS) may modulate neuronal oscillations by applying sinusoidal alternating current, thereby alleviating associated symptoms in schizophrenia. Considering its possible utility in schizophrenia, we reviewed the literature for tACS protocols administered in schizophrenia and their findings. A scoping review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline in databases and clinical trial registers. The search resulted in 59 publications. After excluding review articles unrelated to tACS, trials without published results or not involving patients with schizophrenia, 14 studies were included. Among the included studies/case reports only 5 were randomized controlled therapeutic trials. The studies investigated the utility of tACS for clinical and neurobiological outcomes. All studies reported good tolerability with only transient mild side effects. It was administered mostly during the working memory task (such as computerized n-back task, dual back task, and computerized digit symbol substitution task) for schizophrenia patients with cognitive deficits and during resting state while targeting positive symptoms. A possible reduction in hallucinations and delusions using alpha tACS, and improvement in negative and cognitive deficits with theta and gamma tACS were reported. Nevertheless, one of the randomized controlled trials targeting hallucinations was negative and rigorous large-sample studies are lacking for other domains. The current evidence for tACS in schizophrenia is preliminary though promising. In future, more sham controlled randomized trials assessing the effect of tACS on various domains are needed to substantiate these early findings.
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Affiliation(s)
- Harsh Pathak
- InSTAR Program and WISER Neuromodulation Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Vanteemar S Sreeraj
- InSTAR Program and WISER Neuromodulation Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Ganesan Venkatasubramanian
- InSTAR Program and WISER Neuromodulation Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Hari V, Bose A, Thimmashetty VH, Parlikar R, Sreeraj VS, Venkatasubramanian G. Effect of left temporoparietal transcranial direct current stimulation on self-bias effect and retrospective intentional binding paradigm: A randomised, double-blind, controlled study. Neuropsychologia 2023; 190:108683. [PMID: 37730086 DOI: 10.1016/j.neuropsychologia.2023.108683] [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] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/27/2023] [Accepted: 09/14/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Self-bias effect is expressed as a preferential selection and accelerated perception of self-related sensory information. Intentional binding (IB) is a related phenomenon where the sensory outcome from a voluntary action and the voluntary action itself are perceived to be closer to each other in time in both predictive (voluntary action predicting sensory consequence) and retrospective (sensory consequence features triggering self-related inference) contexts. Recent evidence indicates that self-related visual stimuli can affect retrospective intentional binding (rIB). We aimed to 1) replicate rIB in the auditory context, and 2) investigate the potential role of left temporoparietal junction (l-TPJ), a crucial node for the self-monitoring process, in self-bias effect and intentional binding effect by manipulating l-TPJ activity with neuromodulation [using High-Definition Transcranial Direct Current Stimulation (HD-tDCS)]. We anticipated self-bias and rIB effects to increase with anodal stimulation of l-TPJ in comparison to cathodal-stimulation of l-TPJ. METHODS Fourteen, right-handed, healthy participants performed sound-label matching (matching tones to self-and-other labels) and rIB (estimating time interval between a button press and a self/other labelled tone) tasks. Each participant underwent both anodal and cathodal stimulation of l-TPJ in separate sessions (at least 72 h apart). Assignment of HD-tDCS type was random and counter-balanced across participants. Behavioural data was collected at three time points: once at baseline (no-stimulation), and twice after stimulation with HD-tDCS. RESULTS Strong self-bias effect was observed across all experimental conditions. Neuromodulation of l-TPJ affected processing of other-labelled tone in the sound-label matching task. rIB was noted in baseline and anodal-HD-tDCS conditions where participants exhibited stronger binding for self-associated stimuli compared to other-associated stimuli. CONCLUSION l-TPJ may potentially play a critical role in self-other distinction. This may have possible implications for disorders of self-disturbances like psychosis.
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Affiliation(s)
- Vinaya Hari
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Anushree Bose
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Vani Holebasavanahalli Thimmashetty
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India; Department of Integrative Medicine, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Rujuta Parlikar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
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Mishra S, Johnson L, Gazala MP, Dahiya S, Rahman W, Sreeraj VS. Systemic immune-inflammation index in patients with generalized stage III grade C periodontitis. Oral Dis 2023; 29:3599-3609. [PMID: 35913425 DOI: 10.1111/odi.14328] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/15/2022] [Accepted: 07/24/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Systemic immune-inflammation index (SII) is a novel, inflammatory biomarker whose role in predicting several chronic systemic diseases has been recently identified. However, its association with generalized stage III grade C periodontitis in young adults remains unknown. MATERIAL AND METHODS The study is a multicentered, double-blind, hospital-based case-control clinical study. Periodontal examination comprised of recording plaque index, sites with bleeding on probing, pocket depth and clinical attachment loss for patients with generalized stage III grade C periodontitis and periodontally healthy group. Complete blood counts were obtained and used for calculating SII, neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio. Collected data were then subjected to statistical analyses. RESULTS SII was significantly higher in patients with generalized stage III grade C periodontitis compared to periodontally healthy individuals (723.87 vs. 537.74 × 109 /L, p < 0.0001). SII is associated with severe periodontitis in young adults (odds ratio [OR]:11.86, 95% CI 9.61-20.76, p < 0.0001) after adjusting for factors found significant in univariate analysis. Receiver operative curve analysis demonstrated a fair predictive validity of SII in detecting generalized stage III grade C periodontitis in young adults (AUC: 0.766, 95%CI 0.731-0.799, p < 0.0001, sensitivity 81.27%, specificity 76.50% and diagnostic accuracy 78.89%). SII did not exhibit superior predictive validity when compared with NLR in the context of generalized stage III grade C periodontitis (AUC for SII: 0.766, 95%CI 0.731-0.799, AUC for NLR: 0.788, 95% CI 0.754-0.819; p = 0.28). CONCLUSION SII is associated with generalized stage III grade C periodontitis in young adults.
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Affiliation(s)
- Supriya Mishra
- Department of Periodontics, Government Dental College and Hospital, Raipur, India
| | - Lynn Johnson
- Department of Periodontics, Rama Dental College, Kanpur, India
- Maitri College of Dentistry and Research Centre, Durg, India
| | - M P Gazala
- Department of Periodontics, Government Dental College and Hospital, Raipur, India
| | - Sheetal Dahiya
- Department of Periodontics, Government Dental College and Hospital, Raipur, India
| | - Waheda Rahman
- Department of Periodontics, Government Dental College and Hospital, Raipur, India
| | - V S Sreeraj
- Department of Periodontics, Government Dental College and Hospital, Raipur, India
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Kanakaraj L, Nayok SB, Bose A, Pathak H, Bagali KB, Sreeraj VS, Shivakumar V, Venkatasubramanian G. Extended accelerated tDCS and correction of prediction error signalling in Schizophrenia with atypical hallucinations: A case report. Asian J Psychiatr 2023; 88:103730. [PMID: 37625328 DOI: 10.1016/j.ajp.2023.103730] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023]
Affiliation(s)
- Logesh Kanakaraj
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences, India
| | - Swarna Buddha Nayok
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences, India; Department of Clinical Neurosciences, National Institute of Mental Health And Neuro Sciences, India
| | - Anushree Bose
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences, India.
| | - Harsh Pathak
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences, India
| | | | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences, India
| | - Venkataram Shivakumar
- Department of Integrative Medicine, National Institute of Mental Health And Neuro Sciences, India
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Mishra BR, Biswas T, Sreeraj VS, Nath S, Mohapatra D, Maiti R. Paroxysmal dystonia and psychotic exacerbations in chronic psychosis: Diagnostic dilemmas and preliminary treatment approaches. Br J Clin Pharmacol 2023; 89:2926-2932. [PMID: 37160681 DOI: 10.1111/bcp.15777] [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] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/19/2023] [Accepted: 05/04/2023] [Indexed: 05/11/2023] Open
Abstract
Patients with chronic psychosis on prolonged antipsychotic therapy may present with paroxysmal dystonia along with an exacerbation of their psychotic symptoms: paroxysmal dystonia and psychotic exacerbations (PDPE). The interindividual variability in the clinical presentations of PDPE can pose challenges in its diagnosis and treatment. The objectives of this work are to (i) discuss this rare phenomenon through a series of 10 patients and a relevant literature review, (ii) conceptualize its neurobiological underpinnings, and (iii) explore the preliminary treatment approaches for its management. Acute stress and/or a dysfunctional gamma-aminobutyric acid (GABA) ergic or dopaminergic system may be implicated in the pathogenesis of PDPE. The episodes respond acutely to parenteral benzodiazepines, while long-term management can be achieved by reducing antipsychotic doses, switching to clozapine or using central GABA enhancers. This article is the first attempt at conceptualizing and exploring treatment options for the rare condition PDPE and intends to guide future research in this regard.
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Affiliation(s)
- Biswa Ranjan Mishra
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Tathagata Biswas
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bengaluru, Karnataka, India
| | - Santanu Nath
- Department of Psychiatry, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - Debadatta Mohapatra
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Rituparna Maiti
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Kelkar RS, Currey D, Nagendra S, Mehta UM, Sreeraj VS, Torous J, Thirthalli J. Utility of Smartphone-Based Digital Phenotyping Biomarkers in Assessing Treatment Response to Transcranial Magnetic Stimulation in Depression: Proof-of-Concept Study. JMIR Form Res 2023; 7:e40197. [PMID: 37656496 PMCID: PMC10504622 DOI: 10.2196/40197] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/01/2023] [Accepted: 07/20/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Identifying biomarkers of response to transcranial magnetic stimulation (TMS) in treatment-resistant depression is a priority for personalizing care. Clinical and neurobiological determinants of treatment response to TMS, while promising, have limited scalability. Therefore, evaluating novel, technologically driven, and potentially scalable biomarkers, such as digital phenotyping, is necessary. OBJECTIVE This study aimed to examine the potential of smartphone-based digital phenotyping and its feasibility as a predictive biomarker of treatment response to TMS in depression. METHODS We assessed the feasibility of digital phenotyping by examining the adherence and retention rates. We used smartphone data from passive sensors as well as active symptom surveys to determine treatment response in a naturalistic course of TMS treatment for treatment-resistant depression. We applied a scikit-learn logistic regression model (l1 ratio=0.5; 2-fold cross-validation) using both active and passive data. We analyzed related variance metrics throughout the entire treatment duration and on a weekly basis to predict responders and nonresponders to TMS, defined as ≥50% reduction in clinician-rated symptom severity from baseline. RESULTS The adherence rate was 89.47%, and the retention rate was 73%. The area under the curve for correct classification of TMS response ranged from 0.59 (passive data alone) to 0.911 (both passive and active data) for data collected throughout the treatment course. Importantly, a model using the average of all features (passive and active) for the first week had an area under the curve of 0.7375 in predicting responder status at the end of the treatment. CONCLUSIONS The results of our study suggest that it is feasible to use digital phenotyping data to assess response to TMS in depression. Early changes in digital phenotyping biomarkers, such as predicting response from the first week of data, as shown in our results, may also help guide the treatment course.
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Affiliation(s)
| | - Danielle Currey
- Beth Israel Deaconess Medical Center, Boston, MA, United States
| | | | | | | | - John Torous
- Beth Israel Deaconess Medical Center, Boston, MA, United States
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Nayok SB, Sreeraj VS, Shivakumar V, Venkatasubramanian G. A Primer on Interoception and its Importance in Psychiatry. Clin Psychopharmacol Neurosci 2023; 21:252-261. [PMID: 37119217 PMCID: PMC10157017 DOI: 10.9758/cpn.2023.21.2.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 05/01/2023]
Abstract
Interoception is the perception of signals from inside the body. It plays a significant role in the nervous, cardiovascular, respiratory, gastrointestinal, genitourinary, and endocrine systems. It is also closely related to the autonomic nervous system and inflammatory pathways and plays a significant role in our optimal functioning. Recently, interoception has gained more attention in neuropsychiatric research. Anatomical and physiological aspects of interoception like relevant brain areas, the role of the vagus nerve, and the autonomic nervous system are gradually being understood. Different facets of interoception like interoceptive attention, detection, magnitude, discrimination, accuracy, awareness, and appraisal have been proposed and their assessments and importance are being evaluated. Further, interoception is often dysregulated or abnormal in psychiatric disorders. It has been implicated in the psychopathology, etiopathogenesis, clinical features and treatment of mood, anxiety, psychotic, personality and addiction-related disorders. This narrative review attempts to provide a nuanced understanding of the pathway(s), components, functions, assessments, and problems of interoception and will help us to detect its disturbances and evaluate its impact on psychiatric disorders, leading to a better perspective and management. This will also advance interoception-related research.
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Affiliation(s)
- Swarna Buddha Nayok
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Venkataram Shivakumar
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Ganesan Venkatasubramanian
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Gokulakrishnan K, Nikhil J, Viswanath B, Thirumoorthy C, Narasimhan S, Devarajan B, Joseph E, David AKD, Sharma S, Vasudevan K, Sreeraj VS, Holla B, Shivakumar V, Debnath M, Venkatasubramanian G, Varambally S. Comparison of gut microbiome profile in patients with schizophrenia and healthy controls - A plausible non-invasive biomarker? J Psychiatr Res 2023; 162:140-149. [PMID: 37156128 DOI: 10.1016/j.jpsychires.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
The human gut microbiome regulates brain function through the microbiome-gut-brain axis and is implicated in several neuropsychiatric disorders. However, the relationship between the gut microbiome and the pathogenesis of schizophrenia (SCZ) is poorly defined, and very few studies have examined the effect of antipsychotic treatment response. We aim to study the differences in the gut microbiota among drug-naïve (DN SCZ) and risperidone-treated SCZ patients (RISP SCZ), compared to healthy controls (HCs). We recruited a total of 60 participants, from the clinical services of a large neuropsychiatric hospital, which included DN SCZ, RISP SCZ and HCs (n = 20 each). Fecal samples were analyzed using 16s rRNA sequencing in this cross-sectional study. No significant differences were found in taxa richness (alpha diversity) but microbial composition differed between SCZ patients (both DN and RISP) and HCs (PERMANOVA, p = 0.02). Linear Discriminant Analysis Effect Size (LEfSe) and Random Forest model identified the top six genera, which significantly differed in abundance between the study groups. A specific genus-level microbial panel of Ruminococcus, UCG005, Clostridium_sensu_stricto_1 and Bifidobacterium could discriminate SCZ patients from HCs with an area under the curve (AUC) of 0.79, HCs vs DN SCZ (AUC: 0.68), HCs vs RISP SCZ (AUC: 0.93) and DN SCZ vs RISP SCZ (AUC: 0.87). Our study identified distinct microbial signatures that could aid in the differentiation of DN SCZ, RISP SCZ, and HCs. Our findings contribute to a better understanding of the role of the gut microbiome in SCZ pathophysiology and suggest potential targeted interventions.
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Affiliation(s)
- Kuppan Gokulakrishnan
- Department of Neurochemistry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, 560029, India.
| | - Joyappa Nikhil
- Department of Neurochemistry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, 560029, India
| | - Biju Viswanath
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, 560029, India
| | - Chinnasamy Thirumoorthy
- Department of Neurochemistry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, 560029, India
| | - Sandhya Narasimhan
- Department of Neurochemistry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, 560029, India
| | - Bharanidharan Devarajan
- Department of Bioinformatics, Aravind Medical Research Foundation, Madurai, Tamil Nadu, India
| | - Ebin Joseph
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, 560029, India
| | - Arul Kevin Daniel David
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, 560029, India
| | - Sapna Sharma
- Chair of Food Chemistry and Molecular Sensory Science, Technische Universität München, Lise-Meitner-Str. 34, 85354, Freising, Germany
| | - Kavitha Vasudevan
- Department of Foods, Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, 560029, India
| | - Bharath Holla
- Department of Integrative Medicine, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, 560029, India
| | - Venkataram Shivakumar
- Department of Integrative Medicine, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, 560029, India
| | - Monojit Debnath
- Department of Human Genetics, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, 560029, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, 560029, India
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, 560029, India; Department of Integrative Medicine, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, 560029, India
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Kelkar RS, Sreeraj VS, Mehta UM, Patwardhan AA, Thirthalli J, Blumberger DM. Generalized seizure induced by continuous theta-burst stimulation (cTBS) in a patient with bipolar depression: A case report. Brain Stimul 2023; 16:693-694. [PMID: 37068732 PMCID: PMC7614549 DOI: 10.1016/j.brs.2023.04.009] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/17/2023] [Accepted: 04/15/2023] [Indexed: 04/19/2023] Open
Affiliation(s)
- Radhika Suneel Kelkar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, India.
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, India
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, India
| | - Ameya A Patwardhan
- Neurology division, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, India
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Sreeraj VS, Shivakumar V, Bhalerao GV, Kalmady SV, Narayanaswamy JC, Venkatasubramanian G. Resting-state functional connectivity correlates of antipsychotic treatment in unmedicated schizophrenia. Asian J Psychiatr 2023; 82:103459. [PMID: 36682158 DOI: 10.1016/j.ajp.2023.103459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/03/2023] [Accepted: 01/07/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND Antipsychotics may modulate the resting state functional connectivity(rsFC) to improve clinical symptoms in schizophrenia(Sz). Existing literature has potential confounders like past medication effects and evaluating preselected regions/networks. We aimed to evaluate connectivity pattern changes with antipsychotics in unmedicated Sz using Multivariate pattern analysis(MVPA), a data-driven technique for whole-brain connectome analysis. METHODS Forty-seven unmedicated patients with Sz(DSM-IV-TR) underwent clinical evaluation and neuroimaging at baseline and after 3-months of antipsychotic treatment. Resting-state functional MRI was analysed using group-MVPA to derive 5-components. The brain region with significant connectivity pattern changes with antipsychotics was identified, and post-hoc seed-to-voxel analysis was performed to identify connectivity changes and their association with symptom changes. RESULTS Connectome-MVPA analysis revealed the connectivity pattern of a cluster localised to left anterior cingulate and paracingulate gyri (ACC/PCG) (peak coordinates:x = -04,y = +30,z = +26;k = 12;cluster-pFWE=0.002) to differ significantly after antipsychotics. Specifically, its connections with clusters of precuneus/posterior cingulate cortex(PCC) and left inferior temporal gyrus(ITG) correlated with improvement in positive and negative symptoms scores, respectively. CONCLUSION ACC/PCG, a hub of the default mode network, seems to mediate the antipsychotic effects in unmedicated Sz. Evaluating causality models with data from randomised controlled design using the MVPA approach would further enhance our understanding of therapeutic connectomics in Sz.
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Affiliation(s)
- Vanteemar S Sreeraj
- InSTAR Clinic and Translational Psychiatry Lab, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India.
| | - Venkataram Shivakumar
- InSTAR Clinic and Translational Psychiatry Lab, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India; Department of Integrative Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Sunil V Kalmady
- Alberta Machine Intelligence Institute, Department of Computing Science, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | | | - Ganesan Venkatasubramanian
- InSTAR Clinic and Translational Psychiatry Lab, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Uvais NA, Sreeraj VS, Moideen S, Shahul DK. Central Nervous System Lymphoma Presenting as Psychogenic Vomiting. Prim Care Companion CNS Disord 2023; 25. [PMID: 36763824 DOI: 10.4088/pcc.22cr03256] [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] [Indexed: 01/31/2023] Open
Affiliation(s)
- N A Uvais
- Department of Psychiatry, Iqraa International Hospital and Research Centre, Calicut, India.,Corresponding author: N. A. Uvais, MBBS, DPM, Department of Psychiatry, Iqraa International Hospital and Research Centre, Calicut, India
| | - V S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Shamsudeen Moideen
- Department of Internal Medicine, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
| | - D K Shahul
- Department of Radiology, Iqraa International Hospital and Research Centre, Calicut, India
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Lakkireddy SP, Balachander S, Dayalamurthy P, Bhattacharya M, Joseph MS, Kumar P, Kannampuzha AJ, Mallappagari S, Narayana S, Alexander AC, Muthukumaran M, Sheth S, Puzhakkal JC, Ramesh V, Thatikonda NS, Selvaraj S, Ithal D, Sreeraj VS, Mahadevan J, Holla B, Venkatasubramanian G, John JP, Murthy P, Benegal V, Reddy YCJ, Jain S, Viswanath B. Neurocognition and its association with adverse childhood experiences and familial risk of mental illness. Prog Neuropsychopharmacol Biol Psychiatry 2022; 119:110620. [PMID: 35995305 PMCID: PMC7615105 DOI: 10.1016/j.pnpbp.2022.110620] [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: 02/16/2022] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022]
Abstract
Environmental factors such as adverse childhood experiences (ACEs) may affect neurocognition, an endophenotype for several mental illnesses. This study examines the effect of ACEs on neurocognitive performance in first-degree relatives (FDRs) of patients with severe mental illness to determine whether familial risk has a moderating effect on the relationship between ACEs and neurocognition. Unaffected FDRs from multiplex families with severe mental illnesses (schizophrenia, bipolar disorder, obsessive-compulsive disorder, or alcohol use disorder) (n = 324) and healthy controls (with no familial risk) (n = 188) underwent neurocognitive tests for processing speed, new learning, working memory and Theory of Mind. ACEs were measured using the WHO ACE-International Questionnaire (ACE-IQ). Regression models were done to predict each neurocognitive domain by the effect of familial risk, ACE-IQ Score and their interaction (familial risk*ACE-IQ score). The main effect of familial risk predicted poor performance in all domains of neurocognition (p < 0.01), and the interaction had a negative association with global neurocognition (β = -0.093, p = 0.009), processing speed (β = -0.109, p = 0.003) and working memory (β = -0.092, p = 0.01). Among the ACEs sub-domains, only maltreatment (specifically the main effect of physical neglect and the interaction effect of sexual abuse with familial risk) predicted poorer neurocognition. In FDRs of schizophrenia and bipolar disorder, only the main effects of familial risk were significantly associated with poorer neurocognition. We conclude that there is a relationship between ACEs (especially maltreatment) and neurocognitive functioning, which is moderated by the familial risk of mental illnesses. Genetic/familial vulnerability may have a stronger association with neurocognition in schizophrenia and bipolar disorder.
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Affiliation(s)
- Sai Priya Lakkireddy
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Srinivas Balachander
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India.
| | - Pavithra Dayalamurthy
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Mahashweta Bhattacharya
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Mino Susan Joseph
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Pramod Kumar
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Anand Jose Kannampuzha
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Sreenivasulu Mallappagari
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Shruthi Narayana
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Alen Chandy Alexander
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Moorthy Muthukumaran
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Sweta Sheth
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Joan C Puzhakkal
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Vinutha Ramesh
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Navya Spurthi Thatikonda
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Sowmya Selvaraj
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Dhruva Ithal
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Vanteemar S Sreeraj
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Jayant Mahadevan
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Bharath Holla
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Ganesan Venkatasubramanian
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - John P John
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Pratima Murthy
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Vivek Benegal
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Y C Janardhan Reddy
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Sanjeev Jain
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Biju Viswanath
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India.
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Balachander S, Thatikonda NS, Kannampuzha AJ, Bhattacharya M, Sheth S, Ramesh V, Chandy Alexander A, Muthukumaran M, Joseph MS, Selvaraj S, Ithal D, Sreeraj VS, John JP, Venkatasubramanian G, Viswanath B, Reddy YJ, Jain S. Familial risk of psychosis in obsessive-compulsive disorder: Impact on clinical characteristics, comorbidity and treatment response. J Psychiatr Res 2022; 156:557-563. [PMID: 36368245 PMCID: PMC7615106 DOI: 10.1016/j.jpsychires.2022.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/07/2022] [Revised: 08/12/2022] [Accepted: 10/03/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Family studies in obsessive-compulsive disorder (OCD) indicate higher rates of psychosis among their first-degree relatives (FDRs). However, the etiological and clinical relationships between the two disorders remain unclear. We compared the clinical characteristics and pharmacological treatment response in patients diagnosed with OCD with a family history of psychosis (OCD-FHP), with a family history of OCD (OCD-FHO) and those with sporadic OCD (OCD-S). METHODS A total of 226 patients who met DSM-IV criteria for OCD (OCD-FHP = 59, OCD-FHO = 112, OCD-S = 55) were included for analysis. All patients were evaluated using the Mini International Neuropsychiatric Interview (MINI 6.0.0), Yale-Brown Obsessive-Compulsive Scale (YBOCS), and the Family Interview for Genetic Studies (FIGS). Treatment response was characterized over naturalistic follow-up. RESULTS The three groups did not differ across any demographic or clinical variables other than treatment response. Patients in the OCD-FHP group were found to have received a greater number of trials with serotonin reuptake inhibitors (SRI) [F (2,223) = 7.99, p < 0.001], were more likely to have failed ≥2 trials of SRIs (χ2 = 8.45, p = 0.014), and less likely to have attained remission (χ2 = 6.57, p = 0.037) CONCLUSIONS: We observed that having a relative with psychosis may predispose to treatment resistance in OCD. Further research on the influence of genetic liability to psychosis on treatment response in OCD may offer novel translational leads.
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Affiliation(s)
- Srinivas Balachander
- Accelerator Program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, Karnataka, India; OCD Clinic, Department of Psychiatry, NIMHANS, Bangalore, Karnataka, India.
| | - Navya Spurthi Thatikonda
- Accelerator Program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, Karnataka, India; OCD Clinic, Department of Psychiatry, NIMHANS, Bangalore, Karnataka, India
| | - Anand Jose Kannampuzha
- Accelerator Program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, Karnataka, India; OCD Clinic, Department of Psychiatry, NIMHANS, Bangalore, Karnataka, India
| | - Mahashweta Bhattacharya
- Accelerator Program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, Karnataka, India; OCD Clinic, Department of Psychiatry, NIMHANS, Bangalore, Karnataka, India; Department of Clinical Psychology, NIMHANS, Bangalore, Karnataka, India
| | - Sweta Sheth
- Accelerator Program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Vinutha Ramesh
- Accelerator Program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Alen Chandy Alexander
- Accelerator Program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Moorthy Muthukumaran
- Accelerator Program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, Karnataka, India; Department of Psychiatric Social Work, Bangalore, Karnataka, India
| | - Mino Susan Joseph
- Accelerator Program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Sowmya Selvaraj
- Accelerator Program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Dhruva Ithal
- Accelerator Program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Vanteemar S Sreeraj
- Accelerator Program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, Karnataka, India; OCD Clinic, Department of Psychiatry, NIMHANS, Bangalore, Karnataka, India
| | - John P John
- Accelerator Program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Ganesan Venkatasubramanian
- Accelerator Program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Biju Viswanath
- Accelerator Program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, Karnataka, India; OCD Clinic, Department of Psychiatry, NIMHANS, Bangalore, Karnataka, India
| | - Yc Janardhan Reddy
- Accelerator Program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, Karnataka, India; OCD Clinic, Department of Psychiatry, NIMHANS, Bangalore, Karnataka, India
| | - Sanjeev Jain
- Accelerator Program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
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19
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Chithra U, Samantaray S, Kumar V, K R, Maity K, E N, Akhtar KJ, Parlikar R, Bagali KB, Sreeraj VS, Shreekantiah U, Purohith AN, Shenoy S, Praharaj SK, Goyal N, Mehta UM, Venkatasubramanian G, Thirthalli J. Add-on accelerated continuous theta burst stimulation (a-cTBS) over the left temporoparietal junction for the management of persistent auditory hallucinations in schizophrenia: A case series. Brain Stimul 2022; 15:1511-1512. [PMID: 36410627 DOI: 10.1016/j.brs.2022.11.005] [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: 09/15/2022] [Revised: 11/04/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Uppinkudru Chithra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka State, India
| | - Subham Samantaray
- Central Institute of Psychiatry (CIP), Ranchi, 834006, Jharkhand State, India
| | - Vikas Kumar
- Central Institute of Psychiatry (CIP), Ranchi, 834006, Jharkhand State, India
| | - Rajkumar K
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka State, India
| | - Ketaki Maity
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka State, India
| | - Nathiya E
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka State, India
| | - Khalid Jiya Akhtar
- Central Institute of Psychiatry (CIP), Ranchi, 834006, Jharkhand State, India
| | - Rujuta Parlikar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka State, India
| | - Kiran Basawaraj Bagali
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka State, India
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka State, India.
| | - Umesh Shreekantiah
- Central Institute of Psychiatry (CIP), Ranchi, 834006, Jharkhand State, India
| | - Abhiram Narasimhan Purohith
- Department of Psychiatry, Kasturba Medical College (KMC), Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, 576104, Karnataka, India
| | - Sonia Shenoy
- Department of Psychiatry, Kasturba Medical College (KMC), Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, 576104, Karnataka, India
| | - Samir Kumar Praharaj
- Department of Psychiatry, Kasturba Medical College (KMC), Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, 576104, Karnataka, India
| | - Nishant Goyal
- Central Institute of Psychiatry (CIP), Ranchi, 834006, Jharkhand State, India
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka State, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka State, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka State, India
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20
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Selvaraj S, Shivakumar V, Kavya PV, Mullapudi T, Bhalerao G, Sreeraj VS, Suhas S, Dinakaran D, Parlikar R, Chhabra H, Narayanaswamy JC, Debnath M, Rao NP, Muralidharan K, Venkatasubramanian G. Neurohemodynamic correlates of BDNF gene expression in schizophrenia patients with working memory deficits: A functional MRI study. Asian J Psychiatr 2022; 77:103261. [PMID: 36181754 DOI: 10.1016/j.ajp.2022.103261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/18/2022] [Accepted: 09/14/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Brain-derived neurotrophic factor (BDNF) is involved in neuroplasticity underlying cognitive deficits, including working memory deficits (WMD), in schizophrenia. Methodological challenges and inconsistencies are reported with peripheral BDNF levels. Left dorsolateral prefrontal cortex (DLPFC) is proposed to underlie WMD, though inconsistently. We aimed to explore the correlations between brain activation during working memory task-based functional Magnetic Resonance Imaging (fMRI) and BDNF gene expression in schizophrenia patients with WMD. METHODS 26 patients with schizophrenia with established WMD were recruited for the study. Blood samples were collected to study lymphocyte BDNF gene expression. Patients underwent task-based fMRI to examine the working memory performance and related brain activation. Whole-brain analysis was performed with 2-back > 0-back and 2-back > rest contrast. The peak intensity values of the activation were used for correlation analysis. RESULTS Whole brain analysis with 2-back > rest contrast revealed maximum activation in left DLPFC, Brodmann area 9 (t = 10.54, FWE corrected p < 0.05). The baseline BDNF gene expression correlated positively with the peak intensity of brain activation in left DLPFC (r = 0.365, p = 0.033). Negative symptom score negatively correlated with BDNF gene expression (r = -0.499, p = 0.005) and left DLPFC fMRI activation (r = -0.393, p = 0.023) respectively. CONCLUSION We found a significant positive association between BDNF gene expression and the activation of the DLPFC during the working memory task. This novel observation needs further systematic evaluation to establish the potential role of peripheral BDNF expression in WMD in schizophrenia.
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Affiliation(s)
- Sowmya Selvaraj
- Department of Psychiatry, National Institute of Mental Health And Neurosciences, Bangalore, India.
| | - Venkataram Shivakumar
- Department of Integrative Medicine, National Institute of Mental Health And Neurosciences, Bangalore, India
| | - Paranthaman V Kavya
- Department of Human Genetics, National Institute of Mental Health And Neurosciences, Bangalore, India
| | - Thrinath Mullapudi
- Department of Human Genetics, National Institute of Mental Health And Neurosciences, Bangalore, India
| | - Gaurav Bhalerao
- Department of Psychiatry, National Institute of Mental Health And Neurosciences, Bangalore, India
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health And Neurosciences, Bangalore, India
| | - Satish Suhas
- Department of Psychiatry, National Institute of Mental Health And Neurosciences, Bangalore, India
| | - Damodharan Dinakaran
- Department of Psychiatry, National Institute of Mental Health And Neurosciences, Bangalore, India
| | - Rujuta Parlikar
- Department of Psychiatry, National Institute of Mental Health And Neurosciences, Bangalore, India
| | - Harleen Chhabra
- Department of Psychiatry, National Institute of Mental Health And Neurosciences, Bangalore, India
| | | | - Monojit Debnath
- Department of Human Genetics, National Institute of Mental Health And Neurosciences, Bangalore, India
| | - Naren P Rao
- Department of Psychiatry, National Institute of Mental Health And Neurosciences, Bangalore, India
| | - Kesavan Muralidharan
- Department of Psychiatry, National Institute of Mental Health And Neurosciences, Bangalore, India
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21
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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.
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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
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22
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Daderwal MC, Sreeraj VS, Suhas S, Rao NP, Venkatasubramanian G. Montreal Cognitive Assessment (MoCA) and Digit Symbol Substitution Test (DSST) as a screening tool for evaluation of cognitive deficits in schizophrenia. Psychiatry Res 2022; 316:114731. [PMID: 35926360 DOI: 10.1016/j.psychres.2022.114731] [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: 08/14/2021] [Revised: 07/02/2022] [Accepted: 07/16/2022] [Indexed: 11/28/2022]
Abstract
Cognitive deficit is one of the core features of schizophrenia and is associated with poor functional outcomes. There is a lack of validated criteria to screen and monitor cognitive deficits in schizophrenia. This study aimed to evaluate the concurrent validity and sensitivity of MoCA (Montreal Cognitive Assessment) and DSST (Digit Symbol Substitution Test) in identifying cognitive deficits in Schizophrenia comparing with a comprehensive MCCB [MATRICS (Measurement And Treatment Research to Improve Cognition in Schizophrenia) Consensus Cognitive Battery] equivalent battery. We did clinical and cognitive assessments on 30 patients with schizophrenia and 30 age and gender-matched healthy controls. The Cronbach's Alpha of MoCA was 0.839, and on adding the DSST, it increased to 0.859. In stepwise binary logistic regression, adding DSST to MoCA improved the prediction of cognitive impairment as defined by a comprehensive battery with 86.7% classification accuracy. Receiver operating characteristic curve analysis suggested a score of 25 of MoCA and 59 of DSST as an optimal cut-off in identifying severe cognitive deficits with an additional MoCA cut-off of 27 for identifying mild cognitive deficits. Combined MoCA and DSST is a sensitive and quick method to screen for neurocognitive deficits in schizophrenia.
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Affiliation(s)
| | - Vanteemar S Sreeraj
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India.
| | - Satish Suhas
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India
| | - Naren P Rao
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India
| | - Ganesan Venkatasubramanian
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India
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Abstract
Dengue is an arboviral infection endemic in tropical countries. Neurological sequelae to dengue infection are not uncommon, and psychiatric manifestations are increasingly reported. This narrative review aims to present the varied manifestations, postulated mechanisms, and the available treatment options for psychiatric morbidity associated with dengue. The evidence available from eight observational studies is summarized in this review. Depression and anxiety are noted to be prevalent during both the acute and convalescent stages of the infection. The presence of encephalopathy and other neurological conditions is not a prerequisite for developing psychiatric disorders. However, treatment options to manage such psychiatric manifestations were not specified in the observational studies. Anecdotal evidence from case reports is outlined. Special attention is paid to the role of epigenetic modifications following dengue infections and the role of histone deacetylase inhibitors in the management. DNA methylation inhibitors such as valproic acid play a significant role in reversing stress-, viral-, or drug-induced epigenetic modifications.
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Affiliation(s)
- Damodharan Dinakaran
- Dept. of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Vanteemar S Sreeraj
- Dept. of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Ganesan Venkatasubramanian
- Dept. of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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24
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Nayok SB, Bose A, Bagali KB, Maity K, Sreeraj VS, Shivakumar V, Venkatasubramanian G. Accelerated tDCS improves corollary discharge deficit & prediction error signalling in schizophrenia: A case report. Brain Stimul 2022; 15:1218-1220. [PMID: 36041705 PMCID: PMC7615917 DOI: 10.1016/j.brs.2022.08.014] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/05/2022] [Accepted: 08/23/2022] [Indexed: 11/02/2022] Open
Affiliation(s)
- Swarna Buddha Nayok
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), India; Department of Clinical Neurosciences, National Institute of Mental Health And Neuro Sciences (NIMHANS), India
| | - Anushree Bose
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), India.
| | - Kiran Basawaraj Bagali
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), India
| | - Ketaki Maity
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), India; Department of Nursing, National Institute of Mental Health And Neuro Sciences (NIMHANS), India
| | - Vanteemar S Sreeraj
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), India
| | - Venkataram Shivakumar
- Department of Integrative Medicine, National Institute of Mental Health And Neuro Sciences (NIMHANS), India; WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), India
| | - Ganesan Venkatasubramanian
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), India
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25
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Nayok SB, Sreeraj VS, Shivakumar V, Venkatasubramanian G. Understanding the interoception in schizophrenia through the window of Vagus Nerve Stimulation. Neurosci Biobehav Rev 2022; 141:104844. [PMID: 36037979 DOI: 10.1016/j.neubiorev.2022.104844] [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: 01/29/2022] [Revised: 07/25/2022] [Accepted: 08/22/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Swarna Buddha Nayok
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, Karnataka, India; Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, Karnataka, India.
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, Karnataka, India
| | - Venkataram Shivakumar
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, Karnataka, India
| | - Ganesan Venkatasubramanian
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, Karnataka, India; Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, Karnataka, India
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26
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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.
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27
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Paul AK, Bose A, Kalmady SV, Shivakumar V, Sreeraj VS, Parlikar R, Narayanaswamy JC, Dursun SM, Greenshaw AJ, Greiner R, Venkatasubramanian G. Superior temporal gyrus functional connectivity predicts transcranial direct current stimulation response in Schizophrenia: A machine learning study. Front Psychiatry 2022; 13:923938. [PMID: 35990061 PMCID: PMC9388779 DOI: 10.3389/fpsyt.2022.923938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/19/2022] [Indexed: 11/26/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a promising adjuvant treatment for persistent auditory verbal hallucinations (AVH) in Schizophrenia (SZ). Nonetheless, there is considerable inter-patient variability in the treatment response of AVH to tDCS in SZ. Machine-learned models have the potential to predict clinical response to tDCS in SZ. This study aims to examine the feasibility of identifying SZ patients with persistent AVH (SZ-AVH) who will respond to tDCS based on resting-state functional connectivity (rs-FC). Thirty-four SZ-AVH patients underwent resting-state functional MRI at baseline followed by add-on, twice-daily, 20-min sessions with tDCS (conventional/high-definition) for 5 days. A machine learning model was developed to identify tDCS treatment responders based on the rs-FC pattern, using the left superior temporal gyrus (LSTG) as the seed region. Functional connectivity between LSTG and brain regions involved in auditory and sensorimotor processing emerged as the important predictors of the tDCS treatment response. L1-regularized logistic regression model had an overall accuracy of 72.5% in classifying responders vs. non-responders. This model outperformed the state-of-the-art convolutional neural networks (CNN) model-both without (59.41%) and with pre-training (68.82%). It also outperformed the L1-logistic regression model trained with baseline demographic features and clinical scores of SZ patients. This study reports the first evidence that rs-fMRI-derived brain connectivity pattern can predict the clinical response of persistent AVH to add-on tDCS in SZ patients with 72.5% accuracy.
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Affiliation(s)
- Animesh Kumar Paul
- Alberta Machine Intelligence Institute, University of Alberta, Edmonton, AB, Canada
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
| | - Anushree Bose
- Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
- Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Sunil Vasu Kalmady
- Alberta Machine Intelligence Institute, University of Alberta, Edmonton, AB, Canada
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
| | - Venkataram Shivakumar
- Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
- Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Vanteemar S Sreeraj
- Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
- Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Rujuta Parlikar
- Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
- Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Janardhanan C Narayanaswamy
- Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
- Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Serdar M Dursun
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | | | - Russell Greiner
- Alberta Machine Intelligence Institute, University of Alberta, Edmonton, AB, Canada
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Ganesan Venkatasubramanian
- Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
- Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
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28
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Chhabra H, Selvaraj S, Sreeraj VS, Damodharan D, Shivakumar V, Kumar V, Narayanaswamy JC, Venkatasubramanian G. Functional near-infrared spectroscopy in schizophrenia patients with auditory verbal hallucinations: Preliminary observations. Asian J Psychiatr 2022; 73:103127. [PMID: 35430497 DOI: 10.1016/j.ajp.2022.103127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/07/2022] [Indexed: 11/02/2022]
Abstract
Auditory Signal Detection (ASD) theory postulates that auditory verbal hallucinations (AVH) result from an aberrant association of meaningful connection to abstract noises. In this study, schizophrenia (SZ) patients with persistent AVH (N = 17) and matched controls (N = 25) performed an ASD task with concurrent functional near-infrared spectroscopy recording targetting the left dorsolateral prefrontal cortex (L-DLPFC) and left temporoparietal junction (L-TPJ). During the task, discriminability index had a significant negative correlation, and early deoxyhemoglobin (HbR) latency at L-TPJ positively correlated with AVH scores. Also, patients had significantly lower discriminability, early HbR latency at L-TPJ, and delayed latency at L-DLPFC. This finding suggests the presence of ASD abnormalities and impaired auditory processing in SZ patients with AVH supporting ASD-based pathogenesis.
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Affiliation(s)
- Harleen Chhabra
- Center for Psychophysics, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
| | - Sowmya Selvaraj
- Center for Psychophysics, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
| | - Vanteemar S Sreeraj
- Center for Psychophysics, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
| | - Dinakaran Damodharan
- Center for Psychophysics, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
| | - Venkataram Shivakumar
- Center for Psychophysics, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
| | - Vijay Kumar
- Center for Psychophysics, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
| | - Janardhanan C Narayanaswamy
- Center for Psychophysics, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
| | - Ganesan Venkatasubramanian
- Center for Psychophysics, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India.
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Chithra NK, Suhas S, Sreeraj VS, Venkatasubramanian G. Clinical utility of trifluoperazine in the treatment of obsessive-compulsive disorder: A case report. Asian J Psychiatr 2022; 71:103051. [PMID: 35245723 DOI: 10.1016/j.ajp.2022.103051] [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: 02/02/2022] [Accepted: 02/20/2022] [Indexed: 11/02/2022]
Affiliation(s)
- Nellai K Chithra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), India.
| | - Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), India
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Abstract
Nutraceutical agents and food supplements are commonly used as treatment adjuncts in neuropsychiatric disorders. Curcumin, a bioactive agent obtained from the rhizome of Curcuma longa, with its antioxidant and anti-inflammatory properties, has gained much research attention in the last few decades. In this narrative review, we intend to summarize the evidence available for curcumin as an add-on agent in the management of schizophrenia. We searched PubMed/EBSCO for both human and animal trials utilizing curcumin in the management of schizophrenia. We obtained ten articles (five preclinical and five clinical) from the focused literature search. Clinical research utilizing curcumin in schizophrenia is limited to negative and cognitive symptoms. Available preclinical studies suggest curcumin's utility in ameliorating extrapyramidal and metabolic side effects when given as an adjunct with antipsychotics. Curcumin, as an add-on agent, appears promising to improve the negative and cognitive symptoms of schizophrenia. Notably, curcumin was tolerable and safe in all the randomized human clinical trials. The poor oral bioavailability is, however, a limiting factor in its widespread use.
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Affiliation(s)
- Damodharan Dinakaran
- Dept. of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Vanteemar S Sreeraj
- Dept. of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Ganesan Venkatasubramanian
- Dept. of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Suhas S, Sreeraj VS, Amrutha C, Desai G, Venkatasubramanian G. Is allopurinol a marvel in the endgame of ultra-resistant schizophrenia? Schizophr Res 2022; 241:12-13. [PMID: 35066431 DOI: 10.1016/j.schres.2022.01.009] [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: 06/28/2020] [Accepted: 01/02/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Satish Suhas
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru 560029, India
| | - Vanteemar S Sreeraj
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru 560029, India
| | - Chandrasegaran Amrutha
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru 560029, India
| | - Geetha Desai
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru 560029, India
| | - Ganesan Venkatasubramanian
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru 560029, India.
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Chandran S, Sreeraj VS, Venkatasubramanian G, Sathyaprabha TN, Murthy P. Corpus callosum morphometry in children with prenatal alcohol exposure. Psychiatry Res Neuroimaging 2021; 318:111405. [PMID: 34743066 DOI: 10.1016/j.pscychresns.2021.111405] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 11/19/2022]
Abstract
Alcohol is known to have a neurotoxic effect on the brain of offspring of mothers consuming alcohol during pregnancy. Impact on the neurodevelopment in children who were exposed to alcohol specifically during the antenatal period without any clinically detectable features of fetal alcohol syndrome is less well studied. In this cross-sectional study, structural magnetic resonance imaging (MRI) of the brain was acquired in 28 children whose mothers had consumed alcohol during pregnancy and 30 children of mothers who did not consume alcohol during pregnancy. Areas of Corpus callosum (CC) and its parts in the mid-sagittal section were calculated using morphometric analysis of MRI through Witelson's method. Midbody of CC was found to be significantly smaller in children exposed to alcohol during the prenatal period. CC is a sensitive white matter structure to neurotoxic effects of alcohol during prenatal life. This impact could be visible in developmental age even in those without any clinically detectable features of alcohol exposure.
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Affiliation(s)
- Sajish Chandran
- Department of Neurophysiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), 560061 Bengaluru India
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru India
| | - Talakad N Sathyaprabha
- Department of Neurophysiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), 560061 Bengaluru India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru India.
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Roy AA, Joshi H, Havanur S, Rangarajan SK, Sreeraj VS, Sinha P, Narayanan M, Janakiprasad KK, Alladi S, Sinha S, Saini J, PT S, Varghese M, Venkatasubramanian G, John JP. Role of transcranial direct current stimulation (TDCS) intervention on resting state functional connectivity in early Alzheimer’s disease. Alzheimers Dement 2021. [DOI: 10.1002/alz.054801] [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] [Indexed: 11/09/2022]
Affiliation(s)
- Ashika Anne Roy
- Multimodal Brain Image Analysis Laboratory, National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru India
| | - Himanshu Joshi
- Multimodal Brain Image Analysis Laboratory, National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru India
| | - Setu Havanur
- Multimodal Brain Image Analysis Laboratory, National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru India
| | | | - Vanteemar S Sreeraj
- National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru India
| | - Preeti Sinha
- National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru India
| | - Mariyappa Narayanan
- National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru India
| | | | - Suvarna Alladi
- National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru India
| | - Sanjib Sinha
- National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru India
| | - Jitender Saini
- National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru India
| | - Sivakumar PT
- National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru India
| | - Mathew Varghese
- National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru India
| | | | - John P John
- Multimodal Brain Image Analysis Laboratory, National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru India
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Nayok SB, Pathak H, Suhas S, Thimmashetty VH, Shivaprakash P, Madhu Sudhan RM, Sreeraj VS, Narayanaswamy JC, Venkatasubramanian G. Concurrent conventional & high-definition transcranial direct current stimulation for treatment of schizophrenia with co-morbid obsessive-compulsive disorder: A case report. Brain Stimul 2021; 14:1483-1485. [PMID: 34597856 DOI: 10.1016/j.brs.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 09/26/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022] Open
Abstract
Non-invasive brain stimulation techniques such as conventional transcranial direct current stimulation (tDCS) and high definition tDCS (HD-tDCS) are increasingly being used as add-on treatment options in schizophrenia and obsessive-compulsive disorder (OCD). This is reporting of the use of a novel accelerated, symptom-specific, add-on tDCS (combining conventional and high definition) protocol in a patient with both schizophrenia and OCD. The intervention showed clinical utility by reducing both schizophrenia and OCD symptoms.
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Affiliation(s)
- Swarna Buddha Nayok
- Department of Clinical Neurosciences, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru 560029, Karnataka, India; Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru 560029, Karnataka, India; WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru 560029, Karnataka, India
| | - Harsh Pathak
- Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru 560029, Karnataka, India; WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru 560029, Karnataka, India
| | - Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru 560029, Karnataka, India; WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru 560029, Karnataka, India
| | - Vani H Thimmashetty
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru 560029, Karnataka, India
| | - Prakrithi Shivaprakash
- Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru 560029, Karnataka, India
| | - Ragibommanahalli M Madhu Sudhan
- Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru 560029, Karnataka, India
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru 560029, Karnataka, India; WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru 560029, Karnataka, India.
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru 560029, Karnataka, India; WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru 560029, Karnataka, India
| | - Ganesan Venkatasubramanian
- Department of Clinical Neurosciences, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru 560029, Karnataka, India; Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru 560029, Karnataka, India; WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru 560029, Karnataka, India
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Sreeraj VS, Puzhakkal JC, Holla B, Nadella RK, Sheth S, Balachander S, Ithal D, Ali F, Viswanath B, Muralidharan K, Venkatasubramanian G, John JP, Benegal V, Murthy P, Varghese M, Reddy YJ, Jain S. Cross-diagnostic evaluation of minor physical anomalies in psychiatric disorders. J Psychiatr Res 2021; 142:54-62. [PMID: 34325233 DOI: 10.1016/j.jpsychires.2021.07.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/11/2021] [Accepted: 07/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Minor physical anomalies (MPA) are markers of impaired neurodevelopment during the prenatal stage. Assessing MPA across psychiatric disorders may help understand their shared nature. In addition, MPA in family members would indicate a shared liability and endophenotype potential. We examined familial aggregation of MPA and their role as transdiagnostic and disorder-specific markers of 5 major psychiatric/neuropsychiatric conditions (schizophrenia, bipolar disorder, substance dependence, obsessive-compulsive disorder, and Alzheimer's dementia). METHODS Modified Waldrop's MPA scale was applied on 1321 individuals from 439 transdiagnostic multiplex families and 125 healthy population controls (HC). Stage of fetal development (morphogenetic/phenogenetic)- and anatomical location (craniofacial/peripheral)-based sub-scores were calculated. Familiality and endophenotypic potential of MPA were analyzed with serial negative binomial mixed-effect regression. Cross-diagnostic differences and the effect of family history density (FHD) of each diagnosis on MPA were assessed. Mixed-effects Cox models estimated the influence of MPA on age-at-onset of illness (AAO). RESULTS MPA were found to be heritable in families with psychiatric disorders, with a familiality of 0.52. MPA were higher in psychotic disorders after controlling for effects of sex and intrafamilial correlation. Morphogenetic variant MPA was noted to be lower in dementia in comparison to HC. FHD of schizophrenia and bipolar disorder predicted higher, and that of dementia and substance dependence predicted lower MPA. MPA brought forward the AAO [HR:1.07 (1.03-1.11)], and this was more apparent in psychotic disorders. CONCLUSION MPA are transmissible in families, are specifically related to the risk of developing psychoses, and predict an earlier age at onset. Neurodevelopmentally informed classification of MPA has the potential to enhance the etiopathogenic and translational understanding of psychiatric disorders.
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Affiliation(s)
- Vanteemar S Sreeraj
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India.
| | - Joan C Puzhakkal
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Bharath Holla
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Ravi Kumar Nadella
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Sweta Sheth
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Srinivas Balachander
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Dhruva Ithal
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Furkhan Ali
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Biju Viswanath
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Kesavan Muralidharan
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India.
| | - John P John
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India.
| | - Vivek Benegal
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Yc Janardhan Reddy
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Sanjeev Jain
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India.
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Parekh P, Bhalerao GV, Rao R, Sreeraj VS, Holla B, Saini J, Venkatasubramanian G, John JP, Jain S. Protocol for magnetic resonance imaging acquisition, quality assurance, and quality check for the Accelerator program for Discovery in Brain disorders using Stem cells. Int J Methods Psychiatr Res 2021; 30:e1871. [PMID: 33960571 PMCID: PMC8412227 DOI: 10.1002/mpr.1871] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 01/08/2021] [Accepted: 03/10/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The Accelerator program for Discovery in Brain disorders using Stem cells (ADBS) is a longitudinal study on five cohorts of patients with major psychiatric disorders from genetically high-risk families, their unaffected first-degree relatives, and healthy subjects. We describe the ADBS protocols for acquisition, quality assurance (QA), and quality check (QC) for multimodal magnetic resonance brain imaging studies. METHODS We describe the acquisition and QC protocols for structural, functional, and diffusion images. For QA, we acquire proton density and functional images on phantoms, along with repeated scans on human volunteer. We describe the analysis of phantom data and test-retest reliability of volumetric and diffusion measures. RESULTS Analysis of acquired phantom data shows linearity of proton density signal with increasing proton fraction, and an overall stability of various spatial and temporal QA measures. Examination of dice coefficient and statistical analyses of coefficient of variation in test-retest data on the human volunteer showed consistency of volumetric and diffusivity measures at whole-brain, regional, and voxel-level. CONCLUSION The described acquisition and QA-QC procedures can yield consistent and reliable quantitative measures. It is expected that this longitudinal neuroimaging dataset will, upon its release, serve the scientific community well and pave the way for interesting discoveries.
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Affiliation(s)
- Pravesh Parekh
- ADBS Neuroimaging CentreNational Institute of Mental Health and NeurosciencesBangaloreIndia
- Multimodal Brain Image Analysis LaboratoryNational Institute of Mental Health and NeurosciencesBangaloreIndia
- Department of PsychiatryNational Institute of Mental Health and NeurosciencesBangaloreIndia
| | - Gaurav V. Bhalerao
- ADBS Neuroimaging CentreNational Institute of Mental Health and NeurosciencesBangaloreIndia
- Department of PsychiatryNational Institute of Mental Health and NeurosciencesBangaloreIndia
- Translational Psychiatry LabNational Institute of Mental Health and NeurosciencesBangaloreIndia
| | - Rashmi Rao
- ADBS Neuroimaging CentreNational Institute of Mental Health and NeurosciencesBangaloreIndia
| | - Vanteemar S. Sreeraj
- ADBS Neuroimaging CentreNational Institute of Mental Health and NeurosciencesBangaloreIndia
- Department of PsychiatryNational Institute of Mental Health and NeurosciencesBangaloreIndia
- Translational Psychiatry LabNational Institute of Mental Health and NeurosciencesBangaloreIndia
| | - Bharath Holla
- ADBS Neuroimaging CentreNational Institute of Mental Health and NeurosciencesBangaloreIndia
- Department of PsychiatryNational Institute of Mental Health and NeurosciencesBangaloreIndia
| | - Jitender Saini
- Department of Neuroimaging and Interventional RadiologyNational Institute of Mental Health and NeurosciencesBangaloreIndia
| | - Ganesan Venkatasubramanian
- ADBS Neuroimaging CentreNational Institute of Mental Health and NeurosciencesBangaloreIndia
- Department of PsychiatryNational Institute of Mental Health and NeurosciencesBangaloreIndia
- Translational Psychiatry LabNational Institute of Mental Health and NeurosciencesBangaloreIndia
| | - John P. John
- ADBS Neuroimaging CentreNational Institute of Mental Health and NeurosciencesBangaloreIndia
- Multimodal Brain Image Analysis LaboratoryNational Institute of Mental Health and NeurosciencesBangaloreIndia
- Department of PsychiatryNational Institute of Mental Health and NeurosciencesBangaloreIndia
| | - Sanjeev Jain
- Department of PsychiatryNational Institute of Mental Health and NeurosciencesBangaloreIndia
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Suhas S, Jolly AJ, Nayok SB, S Sreeraj V, Kumar V, Rao N, Venkatasubramanian G. Risk mitigation with the use of clozapine - Quo vadimus. Asian J Psychiatr 2021; 61:102693. [PMID: 34030025 DOI: 10.1016/j.ajp.2021.102693] [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: 04/04/2021] [Revised: 04/15/2021] [Accepted: 05/07/2021] [Indexed: 11/18/2022]
Abstract
The risk of neutropenia decreases significantly after the first year of clozapine initiation, and indefinite hematological monitoring is increasingly questioned. Despite comparable risks of neutropenia, the guidelines for antithyroid drugs - carbimazole and propylthiouracil do not recommend routine hematological monitoring. Assuming a similar pathogenic mechanism, data from antithyroid drugs indicate that neutropenia develops rapidly, and indefinite hematological monitoring misses a large majority of cases in the pre-symptomatic phase. Hence, a more pragmatic strategy of intensive hematological monitoring in the first year of clozapine initiation followed by selective haematological monitoring in case of febrile illnesses or pharyngitis needs to be explored.
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Affiliation(s)
- Satish Suhas
- National Institute of Mental Health and Neurosciences, India
| | | | | | | | - Vijay Kumar
- National Institute of Mental Health and Neurosciences, India.
| | - Naren Rao
- National Institute of Mental Health and Neurosciences, India
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Rangarajan SK, Suhas S, Reddy MSS, Sreeraj VS, Sivakumar PT, Venkatasubramanian G. Domiciliary tDCS in Geriatric Psychiatric Disorders: Opportunities and Challenges. Indian J Psychol Med 2021; 43:351-356. [PMID: 34385730 PMCID: PMC8327869 DOI: 10.1177/02537176211003666] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Subhashini K Rangarajan
- Dept. of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Satish Suhas
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Mukku Shiva Shanker Reddy
- Geriatric Clinic and Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vanteemar S Sreeraj
- WISER Neuromodulation Programme, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Palanimuthu Thangaraju Sivakumar
- Geriatric Clinic and Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ganesan Venkatasubramanian
- WISER Neuromodulation Programme, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Moideen S, Anver PC, Uvais NA, Sreeraj VS, Ul Haq Katshu MZ. Positive Naproxen Test in Psychogenic Fever. Prim Care Companion CNS Disord 2021; 23. [PMID: 34139109 DOI: 10.4088/pcc.20l02630] [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] [Indexed: 10/21/2022] Open
Affiliation(s)
- Shamsudeen Moideen
- Department of Internal Medicine, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
| | - P C Anver
- Department of Medicine, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
| | - N A Uvais
- Department of Psychiatry, Iqraa International Hospital and Research Centre, Calicut, Kerala, India.,Corresponding author: N. A. Uvais, MBBS, DPM, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
| | - V S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Mohammad Zia Ul Haq Katshu
- Institute of Mental Health, University of Nottingham, Nottingham, England.,Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, England
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Bhalerao GV, Sreeraj VS, Bose A, Narayanaswamy JC, Venkatasubramanian G. Comparison of electric field modeling pipelines for transcranial direct current stimulation. Neurophysiol Clin 2021; 51:303-318. [PMID: 34023189 DOI: 10.1016/j.neucli.2021.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Electric field modeling utilizes structural brain magnetic resonance images (MRI) to model the electric field induced by non-invasive transcranial direct current stimulation (tDCS) in a given individual. Electric field modeling is being integrated with clinical outcomes to improve understanding of inter-individual variability in tDCS effects and to optimize tDCS parameters, thereby enhancing the predictability of clinical effects. The successful integration of modeling in clinical use will primarily be driven by choice of tools and procedures implemented in computational modeling. Thus, the electric field predictions from different modeling pipelines need to be investigated to ensure the validity and reproducibility of tDCS modeling results across clinical or translational studies. METHODS We used T1w structural MRI from 32 healthy volunteer subjects and modeled the electric field distribution for a fronto-temporal tDCS montage. For five different computational modeling pipelines, we quantitatively compared brain tissue segmentation and electric field predicted in whole-brain, brain tissues and target brain regions between the modeling pipelines. RESULTS Our comparisons at various levels did not reveal any systematic trend with regards to similarity or dissimilarity of electric field predicted in brain tissues and target brain regions. The inconsistent trends in the predicted electric field indicate variation in the procedures, routines and algorithms used within and across the modeling pipelines. CONCLUSION Our results suggest that studies integrating electric field modeling and clinical outcomes of tDCS will highly depend upon the choice of the modeling pipelines and procedures. We propose that using these pipelines for further research and clinical applications should be subject to careful consideration, and indicate general recommendations.
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Affiliation(s)
- Gaurav V Bhalerao
- Department of Psychiatry, National Institute of Mental Health and Neuroscience (NIMHANS), Bengaluru 560029, India.
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neuroscience (NIMHANS), Bengaluru 560029, India
| | - Anushree Bose
- Department of Psychiatry, National Institute of Mental Health and Neuroscience (NIMHANS), Bengaluru 560029, India
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry, National Institute of Mental Health and Neuroscience (NIMHANS), Bengaluru 560029, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neuroscience (NIMHANS), Bengaluru 560029, India
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Kumar V, Nichenmetla S, Chhabra H, Sreeraj VS, Rao NP, Kesavan M, Varambally S, Venkatasubramanian G, Gangadhar BN. Prefrontal cortex activation during working memory task in schizophrenia: A fNIRS study. Asian J Psychiatr 2021; 56:102507. [PMID: 33388563 DOI: 10.1016/j.ajp.2020.102507] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/15/2020] [Revised: 12/01/2020] [Accepted: 12/08/2020] [Indexed: 11/19/2022]
Abstract
Neurocognitive cognitive deficits including working memory (WM) impairment is a key component of schizophrenia (SCZ). Though a prefrontal cortex (PFC) abnormality is recognised to contribute to WM impairment, the exact nature of its neurobiological basis in SCZ is not well established. Functional near infra-red spectroscopy (fNIRS) is an emerging low-cost neuroimaging tool to study neuro-hemodynamics. In this background, we examined the hemodynamic activity during a WM task in schizophrenia using fNIRS. fNIRS was acquired during computerised N-back (zero-, one- & two-back) task in 15 SCZ patients and compared with 22 healthy controls. Performance in N-back test were calculated using signal detection theory alongside the mean reaction times. Concentration and latencies of oxy-, deoxy-, and totalhaemoglobin, and oxygen saturation were computed from 8*8 optodes positioned over bilateral PFC. SCZ performed poorly as measured by most of the WM parameters (p < 0.05). Lesser deoxyhemoglobin concentration (two > zero, at right BA10, p = 0.006) was noted in the right frontopolar cortex in SCZ surviving multiple-comparison correction. In addition, olanzapine equivalent doses correlated negatively with right frontopolar cortex activation (two > zero back, BA10, ρ = 0.70, p = 0.004) and better performance in two back (false alarm rate, ρ = 0.61, p = 0.015). A delayed but compensatory hyperactivation of right frontopolar cortex noted in SCZ may underlie the WM deficit in SCZ. Future studies are recommended to replicate the role of right frontopolar cortex in WM using larger samples and systematically explore the effect of antipsychotics on them.
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Affiliation(s)
- Vijay Kumar
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of mental health and neurosciences (NIMHANS), Bengaluru, India.
| | - Sonika Nichenmetla
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of mental health and neurosciences (NIMHANS), Bengaluru, India
| | - Harleen Chhabra
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of mental health and neurosciences (NIMHANS), Bengaluru, India
| | - Vanteemar S Sreeraj
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of mental health and neurosciences (NIMHANS), Bengaluru, India
| | - Naren P Rao
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of mental health and neurosciences (NIMHANS), Bengaluru, India
| | - Muralidharan Kesavan
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of mental health and neurosciences (NIMHANS), Bengaluru, India
| | - Shivarama Varambally
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of mental health and neurosciences (NIMHANS), Bengaluru, India
| | - Ganesan Venkatasubramanian
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of mental health and neurosciences (NIMHANS), Bengaluru, India
| | - Bangalore N Gangadhar
- InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of mental health and neurosciences (NIMHANS), Bengaluru, India
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Sreeraj VS, Holla B, Ithal D, Nadella RK, Mahadevan J, Balachander S, Ali F, Sheth S, Narayanaswamy JC, Venkatasubramanian G, John JP, Varghese M, Benegal V, Jain S, Reddy YJ, Viswanath B. Psychiatric symptoms and syndromes transcending diagnostic boundaries in Indian multiplex families: The cohort of ADBS study. Psychiatry Res 2021; 296:113647. [PMID: 33429328 DOI: 10.1016/j.psychres.2020.113647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 12/11/2020] [Indexed: 02/06/2023]
Abstract
Syndromes of schizophrenia, bipolar disorder, obsessive-compulsive disorder, substance use disorders and Alzheimer's dementia are highly heritable. About 10-20% of subjects have another affected first degree relative (FDR), and thus represent a 'greater' genetic susceptibility. We screened 3583 families to identify 481 families with multiple affected members, assessed 1406 individuals in person, and collected information systematically about other relatives. Within the selected families, a third of all FDRs were affected with serious mental illness. Although similar diagnoses aggregated within families, 62% of the families also had members with other syndromes. Moreover, 15% of affected individuals met criteria for co-occurrence of two or more syndromes, across their lifetime. Using dimensional assessments, we detected a range of symptom clusters in both affected and unaffected individuals, and across diagnostic categories. Our findings suggest that in multiplex families, there is considerable heterogeneity of clinical syndromes, as well as sub-threshold symptoms. These families would help provide an opportunity for further research using both genetic analyses and biomarkers.
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Affiliation(s)
- Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Bharath Holla
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Dhruva Ithal
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Ravi Kumar Nadella
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Jayant Mahadevan
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Srinivas Balachander
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Furkhan Ali
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Sweta Sheth
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - John P John
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Vivek Benegal
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Yc Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | -
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India
| | - Biju Viswanath
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
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Ali F, Sreeraj VS, Nadella RK, Holla B, Mahadevan J, Ithal D, Balachander S, Viswanath B, Venkatasubramanian G, John JP, Reddy YCJ, Jain S. Estimating the familial risk of psychiatric illnesses: A review of family history scores. Asian J Psychiatr 2021; 56:102551. [PMID: 33453492 DOI: 10.1016/j.ajp.2021.102551] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/17/2020] [Accepted: 01/05/2021] [Indexed: 11/26/2022]
Abstract
A history of psychiatric illnesses in family members of those diagnosed to have an illness has been of significant interest both in research and in clinical practice. Almost all of the major psychiatric illnesses have a familial component to them, perhaps influenced by genetics and a shared environment or their combination. Systematic attempts have been made to quantify these familial risks, as obtained from family history (FH) of psychiatric illnesses. The methods range from a simple dichotomous or count scores to those quantifying as weighted risks such as the Family history density (FHD) measures. This article reviews the available literature on such FH methods and discusses their advantages and limitations. Validation studies have shown that FHD measures may be preferred over dichotomous measures as indicators of familial risk. However, the FHD method has certain limitations, like mostly relying on categorical diagnosis and ignoring other familial risk factors. By critically analysing various existing density measures based on 'ideal characteristics', we suggest a modified version of FHD that would benefit psychiatric research.
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Affiliation(s)
- Furkhan Ali
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru.
| | - Ravi Kumar Nadella
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru
| | - Bharath Holla
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru
| | - Jayant Mahadevan
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru
| | - Dhruva Ithal
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru
| | - Srinivas Balachander
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru
| | - Biju Viswanath
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru
| | | | - John P John
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru
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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.
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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
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Rangarajan SK, Mukku SSR, Gorthi NV, Jagtap N, Shetty PA, Girimaji A, Sreeraj VS, Selvaraj S, Sivakumar PT, B.K. Y, Shivashankar N, Venkatasubramanian G. Clinical utility of transcranial direct current stimulation and online language training in semantic dementia. Alzheimers Dement 2020. [DOI: 10.1002/alz.045739] [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] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - Preetie A. Shetty
- National Institute of Mental Health and Neurosciences Bengaluru India
| | - Akhila Girimaji
- National Institute of Mental Health and Neurosciences Bengaluru India
| | | | - Sowmya Selvaraj
- National Institute of Mental Health and Neurosciences Bengaluru India
| | - Palanimuthu T. Sivakumar
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India Bengaluru India
| | - Yamini B.K.
- National Institute of Mental Health and Neurosciences Bengaluru India
| | - N. Shivashankar
- National Institute of Mental Health and Neurosciences Bengaluru India
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Someshwar A, Holla B, Pansari Agarwal P, Thomas A, Jose A, Joseph B, Raju B, Karle H, Muthukumaran M, Kodancha PG, Kumar P, Reddy PV, Kumar Nadella R, Naik ST, Mitra S, Mallappagiri S, Sreeraj VS, Balachander S, Ganesh S, Murthy P, Benegal V, Reddy JY, Jain S, Mahadevan J, Viswanath B, Narayanaswamy JC, Sivakumar PT, Kandasamy A, Kesavan M, Mehta UM, Venkatasubramanian G, John JP, Mukherjee O, Purushottam M, Kannan R, Mehta B, Kandavel T, Binukumar B, Saini J, Jayarajan D, Shyamsundar A, Moirangthem S, Vijay Kumar KG, Thirthalli J, Chandra PS, Gangadhar BN, Panicker MM, Bhalla US, Chattarji S, Varghese M, Raghu P, Rao M. Adverse childhood experiences in families with multiple members diagnosed to have psychiatric illnesses. Aust N Z J Psychiatry 2020; 54:1086-1094. [PMID: 32538179 DOI: 10.1177/0004867420931157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Adverse childhood experiences are linked to the development of a number of psychiatric illnesses in adulthood. Our study examined the pattern of adverse childhood experiences and their relation to the age of onset of major psychiatric conditions in individuals from families that had ⩾2 first-degree relatives with major psychiatric conditions (multiplex families), identified as part of an ongoing longitudinal study. METHODS Our sample consisted of 509 individuals from 215 families. Of these, 268 were affected, i.e., diagnosed with bipolar disorder (n = 61), obsessive-compulsive disorder (n = 58), schizophrenia (n = 52), substance dependence (n = 59) or co-occurring diagnoses (n = 38), while 241 were at-risk first-degree relatives who were either unaffected (n = 210) or had other depressive or anxiety disorders (n = 31). All individuals were evaluated using the Adverse Childhood Experiences - International Questionnaire and total adverse childhood experiences exposure and severity scores were calculated. RESULTS It was seen that affected males, as a group, had the greatest adverse childhood experiences exposure and severity scores in our sample. A Cox mixed effects model fit by gender revealed that a higher total adverse childhood experiences severity score was associated with significantly increased risk for an earlier age of onset of psychiatric diagnoses in males. A similar model that evaluated the interaction of diagnosis revealed an earlier age of onset in obsessive-compulsive disorder and substance dependence, but not in schizophrenia and bipolar disorder. CONCLUSION Our study indicates that adverse childhood experiences were associated with an earlier onset of major psychiatric conditions in men and individuals diagnosed with obsessive-compulsive disorder and substance dependence. Ongoing longitudinal assessments in first-degree relatives from these families are expected to identify mechanisms underlying this relationship.
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Affiliation(s)
- Amala Someshwar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.,National Centre for Biological Sciences (NCBS), Bengaluru, India
| | - Bharath Holla
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Preeti Pansari Agarwal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Anza Thomas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Anand Jose
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Boban Joseph
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Birudu Raju
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Hariprasad Karle
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - M Muthukumaran
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Prabhath G Kodancha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Pramod Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Preethi V Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Ravi Kumar Nadella
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Sanjay T Naik
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Sayantanava Mitra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Sreenivasulu Mallappagiri
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Srinivas Balachander
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Suhas Ganesh
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Vivek Benegal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Janardhan Yc Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Jayant Mahadevan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Biju Viswanath
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Dinakaran D, Tholasappa V, Lhamu T, Sreeraj VS, Venkatasubramanian G. Treating post-dengue mania: Is role of valproate and quetiapine related to histone deacetylase inhibition? Bipolar Disord 2020; 22:543-545. [PMID: 32511878 DOI: 10.1111/bdi.12948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/31/2019] [Revised: 02/19/2020] [Accepted: 05/29/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Damodharan Dinakaran
- InSTAR program, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Varshitha Tholasappa
- InSTAR program, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Tshering Lhamu
- InSTAR program, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Vanteemar S Sreeraj
- InSTAR program, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Ganesan Venkatasubramanian
- InSTAR program, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Sreeraj VS, Suhas S, Parlikar R, Selvaraj S, Dinakaran D, Shivakumar V, Narayanaswamy JC, Venkatasubramanian G. Effect of add-on transcranial alternating current stimulation (tACS) on persistent delusions in schizophrenia. Psychiatry Res 2020; 290:113106. [PMID: 32474070 DOI: 10.1016/j.psychres.2020.113106] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 12/31/2022]
Abstract
The utility of non-invasive brain stimulation techniques to alleviate resistant delusions in schizophrenia is an under-researched area. In this study, we report the effectiveness of alpha transcranial alternating current stimulation (tACS) targeting the medial prefrontal cortex in ameliorating persistent delusions. Twelve Schizophrenia patients (N=12) with persistent delusions received add-on treatment with a twice-daily 20-minutes session of 10-Hz tACS. Significant reduction in severity of delusion was noted after 5th day (z=2.67, p<0.01, n=12) with further improvement after 10th day (z=2.52, p=0.01, n=9) of stimulation. Add-on treatment with 10-Hz tACS is a potential therapeutic option for treatment-resistant delusions, which requires further systematic research.
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Affiliation(s)
- Vanteemar S Sreeraj
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health And Neurosciences, Bengaluru, India
| | - Satish Suhas
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health And Neurosciences, Bengaluru, India
| | - Rujuta Parlikar
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health And Neurosciences, Bengaluru, India
| | - Sowmya Selvaraj
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health And Neurosciences, Bengaluru, India
| | - Damodaran Dinakaran
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health And Neurosciences, Bengaluru, India
| | - Venkataram Shivakumar
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health And Neurosciences, Bengaluru, India
| | - Janardhanan C Narayanaswamy
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health And Neurosciences, Bengaluru, India
| | - Ganesan Venkatasubramanian
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health And Neurosciences, Bengaluru, India.
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Sreeraj VS, Bose A, Chhabra H, Shivakumar V, Agarwal SM, Narayanaswamy JC, Rao NP, Kesavan M, Varambally S, Venkatasubramanian G. Working memory performance with online-tDCS in schizophrenia: A randomized, double-blinded, sham-controlled, partial cross-over proof-of-concept study. Asian J Psychiatr 2020; 50:101946. [PMID: 32087502 DOI: 10.1016/j.ajp.2020.101946] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 02/08/2020] [Indexed: 12/12/2022]
Abstract
Combining cognitive retraining with transcranial direct current stimulation (tDCS) has been hypothesized to improve cognitive deficits in schizophrenia. The effect of combining a neuropsychological/psychophysiological task with tDCS, called "online-tDCS" for cognitive enhancement in schizophrenia is not rigorously assessed. In this proof-of-concept study, we aimed at evaluating the effect of a single session online-tDCS on working memory(WM) and its transferability to other cognitive functions. Numerical n-back(NNB), digit symbol substitution test(DSST), emotional matching and labelling test(E-MALT), and anti-saccade eye movement beeforefore and after 20 min tDCS (anode: left dorsolateral prefrontal cortex and cathode: left temporoparietal junction) applied during Sternberg's task(WM-task) were assessed. Twenty-three schizophrenia patients with cognitive deficits were randomized to receive either online-tDCS or offline-tDCS (without simultaneous Sternberg's task) sessions. All patients received one session each of active and sham tDCS in a randomized counterbalanced double-blind cross-over design. RMANOVA revealed a significant interaction effect between tDCS type (Online/Offline) x activeness (active/sham) of tDCS; the reaction time during 2-back performance in the NNB test improved in online-sham (F = 5.23, p < 0.038) but not online-active tDCS session. No significant changes were noted in DSST, E-MALT, and anti-saccade performance. Improved performance after online-sham tDCS suggests that performing the Sternberg's task enhanced 2-back performance. The counterintuitive observation was noted with respect to the non-enhancement of WM performance on combining the task to tDCS. Aberrant plasticity in schizophrenia might attain a transitional ceiling that would have resulted in restriction of enhancement on combining the two plasticity modulators. The transferability of improvement to other cognitive domains could not be ascertained.
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Affiliation(s)
- Vanteemar S Sreeraj
- WISER Neuromodulation Program, Translational Psychiatry Laboratory, Neurobiology Research Center, InSTAR Program, Schizophrenia & Metabolic Clinic, Department of Psychiatry National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
| | - Anushree Bose
- WISER Neuromodulation Program, Translational Psychiatry Laboratory, Neurobiology Research Center, InSTAR Program, Schizophrenia & Metabolic Clinic, Department of Psychiatry National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Harleen Chhabra
- WISER Neuromodulation Program, Translational Psychiatry Laboratory, Neurobiology Research Center, InSTAR Program, Schizophrenia & Metabolic Clinic, Department of Psychiatry National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Venkataram Shivakumar
- WISER Neuromodulation Program, Translational Psychiatry Laboratory, Neurobiology Research Center, InSTAR Program, Schizophrenia & Metabolic Clinic, Department of Psychiatry National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Sri Mahavir Agarwal
- WISER Neuromodulation Program, Translational Psychiatry Laboratory, Neurobiology Research Center, InSTAR Program, Schizophrenia & Metabolic Clinic, Department of Psychiatry National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Janardhanan C Narayanaswamy
- WISER Neuromodulation Program, Translational Psychiatry Laboratory, Neurobiology Research Center, InSTAR Program, Schizophrenia & Metabolic Clinic, Department of Psychiatry National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Naren P Rao
- WISER Neuromodulation Program, Translational Psychiatry Laboratory, Neurobiology Research Center, InSTAR Program, Schizophrenia & Metabolic Clinic, Department of Psychiatry National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Muralidharan Kesavan
- WISER Neuromodulation Program, Translational Psychiatry Laboratory, Neurobiology Research Center, InSTAR Program, Schizophrenia & Metabolic Clinic, Department of Psychiatry National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Shivarama Varambally
- WISER Neuromodulation Program, Translational Psychiatry Laboratory, Neurobiology Research Center, InSTAR Program, Schizophrenia & Metabolic Clinic, Department of Psychiatry National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Ganesan Venkatasubramanian
- WISER Neuromodulation Program, Translational Psychiatry Laboratory, Neurobiology Research Center, InSTAR Program, Schizophrenia & Metabolic Clinic, Department of Psychiatry National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Uvais NA, Nizamie SH, Das B, Katshu MZUH, Sreeraj VS. Gender Differences in Auditory P300 Event-Related Potential in Indian Population. Indian J Psychol Med 2020; 42:198-200. [PMID: 32346264 PMCID: PMC7173660 DOI: 10.4103/ijpsym.ijpsym_329_19] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/20/2019] [Accepted: 12/14/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- N A Uvais
- Department of Psychiatry, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
| | - S Haque Nizamie
- Centre for Cognitive Neurosciences, Kanke, Ranchi, Jharkhand, India.,Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India
| | - Basudeb Das
- Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India
| | | | - V S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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