Study of Neurocognitive Function in Type 2 Diabetes Mellitus Patients Using P300 Event-Related Potential.

BACKGROUND: Diabetes mellitus is the most prevailing metabolic disease. It causes structural and functional alterations in several organs, including the central nervous system. Altered glucose metabolism, atherosclerosis, and inflammation of blood vessels are seen in diabetes. This may lead to neuronal degeneration and decline in cognition. Event-related potential P300 can detect cognitive decline before the emergence of obvious neurological manifestations. OBJECTIVE: The aim of this study is to assess and compare the P300 latencies in subjects with type 2 diabetes mellitus and in nondiabetic subjects and to determine the influence of type 2 diabetes mellitus on cognitive functions. MATERIALS AND METHODS: In this study our sample size was 248 subjects, with type 2 diabetes mellitus patients (n = 124) and healthy controls (n = 124) between the age group of 31 and 60 years. This cross-sectional comparative study was conducted at SRM Medical College Hospital and Research Centre. The subjects were evaluated by a structured interview and they were assessed with a general health questionnaire to rule out any subpsychiatric illness. Fasting and postprandial blood glucose, HbA1c level, lipid profile, and creatinine were estimated. P300 amplitude and peak latencies were recorded using the standard auditory oddball paradigm. RESULTS: The latencies of P300 were significantly increased and the amplitude of P300 was significantly reduced in the diabetic group when compared to the control group (P < .001). P300 latency has a positive correlation with the HbA1c levels (r = 0.136) and the duration of diabetes (r = 0.231). CONCLUSION: Prolongation of P300 latencies and the decreased amplitude in diabetic subjects may suggest the existence of a cognitive decline in individuals with type 2 diabetes compared to healthy individuals.

Recommendations for the optimal care of patients with recent-onset psychosis in the Asia-Pacific region.

Providing optimal care to patients with recent-onset psychosis can improve outcomes and reduce relapse. However, there is a lack of consistency of the implementation of guidelines for such patients across the Asia-Pacific region. We determined a pragmatic set of recommendations for use on a day-to-day basis to help provide optimal care at this crucial stage of illness. The recommendations were developed over a series of meetings by an international faculty of 15 experts from the Asia-Pacific region, Europe, and South Africa. A structured search of the PubMed database was conducted. This was further developed based on the faculty's clinical experience and knowledge of the literature into 10 key aspects of optimal care for patients during the first five years of a diagnosis of a psychotic disorder, with particular relevance to the Asia-Pacific region. Several common principles emerged: adherence to antipsychotic medications is crucial; substance abuse, psychiatric and medical comorbidities should be addressed; psychosocial interventions play a pivotal role; and family members can play a vital role in overall patient care. By following these recommendations, clinicians may improve outcomes for patients with recent-onset psychosis.

Psychiatrists' awareness of partial and nonadherence to antipsychotic medication in schizophrenia: results from an Asia-Pacific survey.

BACKGROUND: Nonadherence is a well-known problem among schizophrenia patients, among whom relapse is fivefold more likely, adversely affecting health, employment, and social functioning. The Spanish Adherencia Terapéutica en la Esquizofrenia (ADHES) survey was developed to determine the scope and causes of medication nonadherence in schizophrenia. METHODS: The 20-question ADHES survey was distributed to 19,370 psychiatrists in 13 Asia-Pacific countries in January-April 2012, to ascertain psychiatrists' perceptions of antipsychotic medication adherence levels among their schizophrenia patients, reasons for partial/nonadherence, their preferred methods of assessing adherence, and strategies to improve adherence. Responses are reported as mean and range across countries. RESULTS: Four thousand, six hundred sixty one psychiatrists (24% of recipients) completed the survey (highest contributors: People's Republic of China, 1854; India, 1616). Psychiatrists perceived that 56% (range, 30%-71%) of schizophrenia patients were non- or partially adherent to medication. Patients discontinue medication primarily due to lack of insight into their condition (mean, 37%; 1%-65%) and because patients consider medication unnecessary when feeling better (mean, 27%; 15%-68%). Over half of psychiatrists (mean, 55%; 42%-99%) assess medication adherence at every visit, almost exclusively (81%) by asking their patients, versus quantitative measures. One in three psychiatrists expressed their preference to switch to or add a long-acting antipsychotic to improve adherence (15%-82%). CONCLUSIONS: The substantial prevalence of partial/nonadherence to medication demonstrates that more proactive management of patients with schizophrenia is needed to improve adherence and thereby treatment outcomes. REGISTRATION: Registration of this study was not required.