Comparison of first-episode and multiple-episode bipolar disorder: A surface-based morphometry study.

It is still unclear whether the structural abnormalities in Bipolar disorder (BD) are static or progressive. We aimed to compare differences in cortical thickness, surface area, and volume between patients with BD and healthy volunteers (HV) and to examine whether there are differences between patients who have had a single manic episode and those with multiple episodes. We recruited 30 patients with Type I BD and 30 age and sex matched HV. All participants underwent structural magnetic resonance imaging. Cortical volume, thickness, and surface area were measured using the QDEC tool from the Freesurfer software with age and intracranial volume as covariates. Study groups were comparable across age, sex distribution, and intracranial volume. Patients had significantly lower surface area in bilateral cuneus, right postcentral gyrus, and rostral middle frontal gyri; and lower cortical volume in the left middle temporal gyrus, right postcentral gyrus, and right cuneus. BD patients with multiple episodes had lower cortical measures while those with single episode had cortical measures comparable to HV. Findings indicate that the pathophysiological processes in BD are possibly progressive in nature. Our findings underscore the potential importance of early diagnosis and intervention in preventing deterioration and improving functional recovery.

Psychiatric comorbidity in persons with high-functioning autism spectrum disorders: Findings from a tertiary care neuropsychiatric hospital.

BACKGROUND: The literature on co-morbid psychiatric illnesses in adults with high-functioning autism (HFA) spectrum disorder is sparse. PURPOSE: To examine the nature of psychiatric comorbidity and treatment response in adults with HFA spectrum disorder. MATERIALS AND METHODS: Case records of subjects (age ≥17 years) who presented over a period of 16 years with primary psychiatric symptoms and further detected to have an HFA spectrum disorder, were analyzed. Autism spectrum disorders (ASD) along with near normal to normal verbal communication and general intelligence were considered as HFA spectrum disorders. RESULTS: 33 subjects met the study criteria. Nine subjects (27%) were diagnosed to have an underlying Asperger's syndrome and the rest 24 (73%) had pervasive developmental disorders unspecified (PDD NOS). None of the subjects were diagnosed to be suffering from ASD prior to the visit to our hospital. Mean age at the time of psychiatric consultation was 22.7 (s.d=4.8) years and mean age at the onset of psychiatric comorbidity was 16.48 (s.d=4.4) years. Nearly half of the sample had more than one type of psychiatric illness. Most common lifetime psychiatric diagnosis was obsessive-compulsive disorder (OCD) (n=16, 48.4%). Bipolar disorder (BD) was the second most common type of psychiatric manifestation (n=13, 39.3%) followed by psychotic spectrum disorders (n=9, 27.2%). Overall response to treatment was minimal. CONCLUSIONS: Individuals with HFA spectrum disorders suffer from multiple psychiatric comorbidities. OCD is the most common type of psychiatric comorbidity followed by BD and psychotic spectrum disorders. Comorbid psychiatric illnesses in individuals with HFA show poor response to treatment.

Baclofen Overdose Presenting as Psychosis with Catatonia.

Baclofen is a centrally acting gamma-aminobutyric acid receptor agonist with many therapeutic uses in neurology and psychiatry. An overdose of baclofen is known to cause serious side effects such as encephalopathy, seizures, respiratory depression, and delirium. Association of baclofen with psychosis has also been reported. In this case report, we are highlighting the manifestation of catatonic features in addition to psychosis following baclofen overdose.

Catatonia among women with postpartum psychosis in a Mother-Baby inpatient psychiatry unit.

OBJECTIVE: The aims of the present study were to determine the prevalence of catatonia in women with postpartum psychosis, describe its socio demographic, clinical and obstetric correlates and identify predictors of treatment response. METHODS: Data was extracted from clinical charts of 200 women with postpartum psychosis admitted to an inpatient mother baby unit (MBU) in India over a 3year period. RESULTS: Of the 200 patients, 20% (n=40) had symptoms of catatonia. Mean catatonia score on the Bush Francis Catatonia Rating Scale (BFCRS) was 14.97±3.2. The most frequent catatonic feature was mutism (n=40, 100%). Adequate response to lorazepam trial in catatonia was seen in half the women (n=18/36), with longer duration of untreated catatonia being associated with poorer response. An adequate response to Electroconvulsive therapy (ECT) was seen in 19 women who did not respond to the lorazepam trial. Women with catatonia had significantly higher rates of onset within the first four weeks of postpartum period (50% vs 31.5%, P=0.022) and a longer duration of untreated psychosis at presentation (79.46±159.88 vs 56.12±47.26, P=0.002) compared to mothers without catatonia. CONCLUSION: Catatonic symptoms were identified in one-fifth (20%) of women with postpartum psychosis. Early identification and treatment of catatonia are essential for rapid control of symptoms in this vulnerable population.

Psychosis as a late manifestation of Sheehan's syndrome.

Sheehan's syndrome occurs as a result of ischemic pituitary necrosis due to severe postpartum haemorrhage. It is one of the most common causes of hypopituitarism in underdeveloped or developing countries. Characteristic manifestations include failure to lactate or to resume menses, genital and axillary hair loss, asthenia and weakness, fine wrinkles around the eyes and lips, signs of premature aging, dry skin, hypopigmentation and other evidence of hypopituitarism. Uncommonly it can present with psychosis. There are only few case reports of psychoses in patients with Sheehan's syndrome. Our case report illustrates the relationship between psychosis and Sheehan's syndrome. The treatment challenges in managing Sheehan's syndrome and psychosis are discussed.

Battery for ECT Related Cognitive Deficits (B4ECT-ReCoDe): development and validation.

BACKGROUND: The use of electroconvulsive therapy (ECT) in treatment of psychiatric disorders is associated with adverse cognitive effects. There is a need to develop a short assessment tool of cognitive functions during the course of ECT. OBJECTIVE: This study aimed at developing and validating a short, sensitive battery to assess cognitive deficits associated with ECT in India. METHODS: Battery for ECT Related Cognitive Deficits (B4ECT-ReCoDe), a brief cognitive battery (20-30 min) to assess verbal, visual, working and autobiographic memory, sustained attention, psychomotor speed and subjective memory impairment, was administered to 30 in-patients receiving bilateral ECT, one day after the 1st, 3rd and 6th ECT. Data was analysed using repeated measures analysis of variance and Pearson's correlation. RESULTS: Significant deficits were found in verbal, visual and autobiographic memory, psychomotor speed. Subjective experience of memory loss correlated positively with verbal memory impairment. CONCLUSIONS: B4ECT-ReCoDe, a brief, sensitive measure of cognitive impairments associated with ECT can be used in routine clinical practice.