Cognitive and negative symptoms in schizophrenia with L-Carnosine adjuvant therapy - A randomized double-blind placebo-controlled study.

The antioxidant L-Carnosine is reported to improve negative and cognitive symptoms in Schizophrenia. A randomized double-blind placebo-controlled study was planned to study the effectiveness of adjuvant L-Carnosine therapy in patients with Schizophrenia. 100 eligible patients with predominant negative symptoms as measured by scale for assessment of negative symptoms (SANS total score ≥ 60) and Schizophrenia diagnosis (International Classification of Disorder-Tenth Edition, ICD-10) were recruited. They were randomly allocated to receive a fixed dose of either 400 mg L-Carnosine or identical placebo for 3 months and increased to 800 mg from 13th week till completion of study. Primary outcome measures assessed changes in SANS scores with L-Carnosine at 24 weeks compared to baseline, 4 and 12 weeks. Secondary outcome measures were done to assess the improvement in cognitive symptoms (executive function, attention, and memory) at 24 weeks using subtests of NIMHANS (National Institute for Mental Health and Neurosciences) cognitive battery. Side effects were assessed using adverse events reporting form. The attention scores (p = .023) showed significant differences in patients receiving 800 mg of L-Carnosine at the end of the study. There were no significant differences in negative symptoms in the two arms at study completion. L-Carnosine dosing of 800 mg may be a promising agent to enhance executive functions in Schizophrenia.

Evolution of Community Telepsychiatry in India Showcasing the SCARF Model.

This review chronicles the origin of telepsychiatry services started by the Schizophrenia Research Foundation (SCARF) in the community and traces the birth of the Scarf Telepsychiatry in Pudukkottai (STEP) program at Pudukkottai in Tamil Nadu. This paper also examines the trajectory of STEP and highlights other relevant models existing in the country in the last decade.

Title of the article: Sex hormones and psychopathology in drug naïve Schizophrenia.

Association of Prolactin levels & symptoms in first episode drug naïve Schizophrenia have been equivocal. This cross-sectional comparative study in a tertiary setting was conceived to examine the role of Sex hormones and symptoms in first episode untreated schizophrenia. To measure & compare the circulating estradiol, testosterone & prolactin levels in drug naïve first episode patients with Schizophrenia & healthy age matched controls. To test the association between stress, illness and psychopathology with hormone levels.In a cross-sectional Comparative study 102 subjects (Patients vs Healthy Controls)were enrolled. First episode drug naïve patients (N = 51)with International Classification of Diseases-10 (ICD-10) diagnosis of Schizophrenia were recruited by consecutive sampling. Symptom severity was measured using Positive and Negative Symptom Scale (PANSS).Sex hormone estimation was done at baseline using radioimmunoassay method (RIA) prior to antipsychotic initiation. 51 healthy controls were recruited to participate in the study. Mildly elevated prolactin levels were associated with higher total PANSS scores in women. Hallucinatory behavior and Grandiosity are positively correlated in patients with raised prolactin levels at baseline. Testosterone and estradiol were not associated with psychopathology. Women perceived more stress than men. Elevated prolactin levels in drug naïve Schizophrenia can be a putative marker for predicting gender differences in symptom severity and treatment responses in future.

Psychometric properties of Tamil version of Body Weight Image and Self Esteem questionnaire (BWISE) in severe mental illness in a South Indian population.

BACKGROUND: Body weight image self-esteem questionnaire (BWISE) has been recently developed to assess psychosocial adjustment related to antipsychotic induced weight gain in Schizophrenia and related disorders. Patients have reported disturbance in body image and poor self esteem due to weight gain leading to treatment non-adherence. AIM: Assessment of psychometric properties of Tamil version of Body weight image self-esteem questionnaire (BWISE) in our population. METHODOLOGY: In a cross sectional, validation study conducted at Schizophrenia Research Foundation (SCARF), 203 consenting outpatients with DSM IV diagnosis of Schizophrenia and related psychotic disorder fulfilling inclusion/exclusion criteria were administered BWISE. RESULTS: The mean age of the sample was 38.21 ±â€¯10.32 years. BWISE ratings showed that patients (54%) reported weight gain with current medications and were aware of increase in weight. Only three percent reported to have severe psychosocial adjustment to the weight gain while remaining reported moderate (55%) and mild (42%) psychosocial adjustment. Validation of Tamil version of BWISE was found to be of moderate range (internal consistency 0.55-0.72). Principal Component analysis of BWISE identified 3 components with a 50.36% variance. CONCLUSIONS: BWISE could be used as a useful screening instrument to assess the psychosocial consequences of weight gain in patients.

Role of Novel Dietary Supplement N-acetyl Cysteine in Treating Negative Symptoms in Schizophrenia: A 6-Month Follow-up Study.

BACKGROUND: Abnormal metabolism of dopamine and glutamate in schizophrenia induces oxidative stress that is exacerbated by brain glutathione (GSH) deficiency. N-acetyl cysteine (NAC) increases brain GSH levels and is being used as an adjunctive agent in patients with schizophrenia. This open-label exploratory study in a naturalistic setting was conceived to examine the efficacy of NAC augmentation in treating negative syndrome in schizophrenia. AIMS: To examine the efficacy of add-on NAC (1200 mg) in treating negative symptoms measured using Scale for the Assessment of Negative Symptoms (SANS) and clinical global impression (CGI) at baseline and 24 weeks. SUBJECTS AND METHODS: In a 24-week feasibility study with open-label design, thirty patients with the International Classification of Diseases-Tenth Edition diagnosis of schizophrenia were recruited. Eligible patients were required to have been treated with stable dose of clozapine or amisulpride for negative symptoms for a minimum period of 8 weeks were selected for the study. The subjects were assigned to receive NAC (1.2 g/day) as an add-on treatment. Severity of negative symptoms was measured using SANS and CGI-severity at baseline and improvement with NAC measured using CGI-improvement at 24 weeks. Serum interleukin-6 was assessed before NAC initiation at baseline. RESULTS: NAC augmentation showed a significantly greater improvement in negative symptoms on total SANS and CGI scores at 24 weeks. CONCLUSIONS: NAC may be effective as an adjunct for the treatment of negative symptoms in schizophrenia.

Symptoms at Onset in First Episode Schizophrenia: Caregivers Perspectives.

BACKGROUND: Early recognition of symptoms is important in the management of psychosis. Caregivers understanding and attribution of symptoms plays a major role in treatment selection. AIM: The aim was to identify the various symptoms cluster recognized by caregivers at illness onset in first episode schizophrenia. SUBJECTS AND METHODS: In a cross-sectional study 40 key caregivers of patients with first episode of Schizophrenia (International Classification of Diseases-10) attending the outpatient services of Schizophrenia Research Foundation were recruited. Caregivers were assessed using a questionnaire adapted from the Psychiatric and Personal History Schedule. STATISTICAL ANALYSIS: Principal component (PCP) analysis. RESULTS: Caregivers were predominantly women. Parents (58%), siblings (18%), spouse (12%), and children (12%) formed the sample. The caregiver easily recognized depressive symptoms. An analysis was done to analyze symptom data rated on the caregiver questionnaire indicated a four-factor solution. PCP analysis produced a clear depressive, anxious, irritable, and vegetative factor (Eigenvalue >0.05). Caregivers (40%) attributed present lifestyle as causality. The first contact of help in almost half of the sample (45%) was to a psychiatric facility. CONCLUSION: Caregiver's perception about mental illness and ability to identify the four factors has important treatment implications. Studying patterns of help seeking may be a useful strategy in early intervention programs.

Hearing Voices in Different Cultures: A Social Kindling Hypothesis.

This study compares 20 subjects, in each of three different settings, with serious psychotic disorder (they meet inclusion criteria for schizophrenia) who hear voices, and compares their voice-hearing experience. We find that while there is much that is similar, there are notable differences in the kinds of voices that people seem to experience. In a California sample, people were more likely to describe their voices as intrusive unreal thoughts; in the South Indian sample, they were more likely to describe them as providing useful guidance; and in our West African sample, they were more likely to describe them as morally good and causally powerful. What we think we may be observing is that people who fall ill with serious psychotic disorder pay selective attention to a constant stream of many different auditory and quasi-auditory events because of different "cultural invitations"-variations in ways of thinking about minds, persons, spirits and so forth. Such a process is consistent with processes described in the cognitive psychology and psychiatric anthropology literature, but not yet described or understood with respect to cultural variations in auditory hallucinations. We call this process "social kindling."

Raloxifene trial in postmenopausal woman with treatment-resistant schizophrenia.

Raloxifene augmentation in postmenopausal women with schizophrenia has shown promising results. Younger patients diagnosed as treatment-resistant schizophrenia and treated with raloxifene (120 mg/day) have reported significant improvement in symptoms. This case highlights how raloxifene, a selective estrogen receptor modulator (SERM), can play a major role in alleviating positive and negative symptoms in postmenopausal women with treatment-resistant schizophrenia.

Sexual dysfunctions in schizophrenia: Professionals and patients perspectives.

BACKGROUND: Sexual dysfunction (SD) is not commonly reported by persons with schizophrenia unless an enquiry is made by a doctor or staff during routine clinical visits. MATERIALS AND METHODS: A cross-sectional study was carried out to determine reporting of drug-induced sexual side-effects and the attitude of the treating team in clarifying or detecting this issue. RESULTS: A vast majority of professionals (73.2%) did not enquire about SDs in routine clinical setting and admitted that they lack expertise based on the Attitude Survey Questionnaire. More than one-third of the patients (35.3%) attributed sexual side-effects to medications. Many patients (91.7%) reported good to fair tolerance to sexual side-effects according to the Psychotropic Related Sexual Dysfunction Questionnaire. CONCLUSION: The treating team plays a crucial role. Sexual side-effects are often under-reported and need to be addressed by the treating physician.

Tardive dyskinesia with low dose amisulpride.

In recent years, there has been an increasing trend to use amisulpride in the treatment of dysthymia and also as an adjunct treatment in patients with major depression. At low doses (50 mg), amisulpride preferentially blocks presynaptic auto receptors, enhances dopamine release, and therefore acts as a dopaminergic compound able to resolve the dopaminergic hypo activity that characterizes depression. Based on experimental data, amisulpride is the drug of choice for dopaminergic transmission disorders, both in depression and in schizophrenia. This case highlights the development of dyskinesia in a depressed patient treated with low dose amisulpride and fluvoxamine.

Study of the association of serotonin transporter triallelic 5-HTTLPR and STin2 VNTR polymorphisms with lithium prophylaxis response in bipolar disorder.

The 5-hydroxy tryptamine transporter (5-HTT) gene has been previously implicated in lithium response, but the roles of the triallelic 5-HTT linked promoter region (5-HTTLPR) and variable number tandem repeats in the second intron [serotonin transporter intron 2 (STin2)] have not been reported. We examined these polymorphisms in 122 patients with bipolar I disorder, among which 49 patients were classified as good responders, 49 as nonresponders, and 24 as partial responders to lithium prophylaxis. We observed significant variation in the genotype frequencies of STin2 polymorphism among the response groups (P=0.02). There was also a significant association of haplotype consisting of the S allele of 5-HTTLPR and 10 repeat allele of STin2 with lithium response (P=0.01) and no such relationship was found with 5-HTTLPR variants. Our data support preliminary information of a possible association of STin2 and its combined effect with 5-HTTLPR variants with lithium response and also suggest that lithium is likely to be more effective for patients carrying 5-HTT polymorphisms associated with reduced transcriptional activity.

Birth order and psychopathology.

CONTEXT: Ordinal position the child holds within the sibling ranking of a family is related to intellectual functioning, personality, behavior, and development of psychopathology. AIM: To study the association between birth order and development of psychopathology in patients attending psychiatry services in a teaching hospital. SETTINGS AND DESIGN: Hospital-based cross-sectional study. MATERIALS AND METHODS: Retrospective file review of three groups of patients was carried out. Patient-related variables like age of onset, birth order, family type, and family history of mental illness were compared with psychiatry diagnosis (ICD-10) generated. STATISTICAL ANALYSIS: SPSS 13; descriptive statistics and one-way analysis of variance (ANOVA) were used. RESULTS: Mean age of onset of mental illness among the adult general psychiatry patients (group I, n = 527) was found to be 33.01 ± 15.073, while it was 11.68 ± 4.764 among the child cases (group II, n = 47) and 26.74 ± 7.529 among substance abuse cases (group III, n = 110). Among group I patients, commonest diagnosis was depression followed by anxiety and somatoform disorders irrespective of birth order. Dissociative disorders were most prevalent in the first born child (36.7%) among group II patients. Among group III patients, alcohol dependence was maximum diagnosis in all birth orders. CONCLUSIONS: Depression and alcohol dependence was the commonest diagnosis in adult group irrespective of birth order.

Association of dopamine, serotonin, and nicotinic gene polymorphisms with methylphenidate response in ADHD.

Gene polymorphisms of the 3' untranslated region (3'-UTR) of the dopamine transporter (DAT1), Dopamine receptor exon 3 D4 variable number tandem repeat (DRD4VNTR), nicotinic acetylcholine receptor alpha 4 subunit (CHRNA4) and serotonin transporter promoter (SLC6A4-5HTTLPR) are under consideration as potential risk factors for attention-deficit/hyperactivity disorder (ADHD). A post-hoc attempt was made to investigate the association between the allelic variations of these candidate genes and retrospective parental report of response to methylphenidate in an ADHD-enriched, population-based twin sample. Subjects (N = 243) were selected from the twin sample based on parent report that the child had been treated with methylphenidate for ADHD symptoms. The functional polymorphisms screened were the VNTR located in the 3'-UTR of the dopamine transporter, DRD4 VNTR, CHRNA4 (rs1044396 and rs6090384) and the long (L(A) and L(G)) and short (S) forms of the serotonin transporter promoter region. Logistic regression did not demonstrate a significant association between methylphenidate treatment response and the relevant polymorphisms. The sample size had high power to detect effect sizes similar to those reported in some prior methylphenidate pharmacogenetic studies; however, the categorical (yes/no) measure of parent-reported treatment response may not have been sensitive enough to pick up statistically significant differences in treatment response based on genotype. Further studies including quantitative measures of treatment response are warranted.

A cross-sectional comparison of disability and quality of life in euthymic patients with bipolar affective or recurrent depressive disorder with and without comorbid chronic medical illness.

BACKGROUND: There are major health care implications of quality of life (QOL) and disability in long-standing disorders such as bipolar affective disorder (BAD) and recurrent depressive disorder (RDD). OBJECTIVES: To compare the inter-episode QOL and disability in patients with the diagnosis of BAD or RDD in remission with and without comorbid chronic medical illness. MATERIALS AND METHODS: Cross-sectional assessments of the four groups were carried out. Euthymic bipolar or RDD subjects with chronic comorbid medical illnesses were included in the study. QOL assessment was carried out using the World Health Organization (WHO)-QOL - Bref Kannada version. Disability was assessed using the Schedule for Assessment of Psychiatric Disability (SAPD), which is an Indian modification of the WHO Disability Assessment Schedule-II. RESULTS: Eighty patients were enrolled into the study (20 patients in each group). The mean disability scores in the BAD group was significantly more in 'social role' (P = 0.038), and in the RDD group it was more in 'home atmosphere' (P = 0.001) in the two groups (n = 40) with chronic comorbid medical illness. In the other group without comorbid chronic medical illness (n = 40), the BAD group had significantly more disability in 'overall behavior' (P = 0.002) and 'social role' (P = 0.001), and the RDD group had significantly more disability in 'assets and/or liabilities' (P = 0.004) and 'home atmosphere' (P = 0.001). The QOL measures did not differ significantly between the two disorders. CONCLUSIONS: The presence of chronic comorbid medical illness did not cause a difference in the QOL between the two groups in periods of euthymia. However, disability measures differed significantly between the groups.

Catatonic syndrome as a complication of enteric Fever.

A person with enteric fever who developed neuropsychiatric complication of catatonia after the fever subsided is presented. The catatonic symptoms were not associated with any depressive or psychotic symptoms. The relevant literature is discussed.