An open-label study of oral acetazolamide for the prevention of antipsychotic associated weight gain.

Background: Weight gain associated with atypical antipsychotic medications need to be well managed. We set out: 1. To test the effect of acetazolamide on weight gain associated with antipsychotics 2. To assess improvement in psychotic symptoms using the Brief Psychiatric Rating Scale score on patients receiving acetazolamide. Methods and Materials: This open-label study conducted after institutional ethical clearance from December 2018 to August 2020 included 34 drug-naive patients or patients on antipsychotic risperidone or olanzapine for less than one month. They were divided into two groups of 17 each as a case group (treatment as usual + acetazolamide) and a control group (treatment as usual) who were followed up for eight weeks. The patient's physical characteristics were recorded at baseline and during follow-ups. The Brief psychiatric rating scale (BPRS) and clinical global impression (CGI) scores were compared for the cases and controls. Results: The study showed non-significant reduction in the weight (-0.57 ± 1.06 kg), body mass index (BMI) (-0.23 ± 0.76 kg/m2) and abdominal circumference (-0.47 ± 1.37 cm) in the patients receiving oral acetazolamide at the end of two months as compared to controls where there was significant increase in the weight (+2.62 ± 1.09 kg), BMI (+1.03 ± 0.44 kg/m2) and abdominal circumference (+2.21 ± 1.33 cm, P = 0.001). Similarly, the BPRS and CGI scores were significantly reduced in both arms, with satisfaction rates better among the cases compared to controls. Conclusion: There was a non-significant reduction in the weight, body mass index, abdominal circumference, and brief psychiatric rating scale scores in patients treated with acetazolamide.Ethics committee protocol number: - 2018/244CTRI India registration number: CTRI/2019/05/018884.

Stigma and discrimination among persons with mental illness in a tertiary care medical institution in Southern India.

The proportional contribution of mental disorders to the total disease burden in India has almost doubled since 1990. Stigma and discrimination are major barriers to seeking treatment for persons with mental illness (PMI). Stigma reduction strategies are thus crucial, and for this, there needs to be an understanding of the various factors associated with them. The current study intended to assess stigma and discrimination in PMI visiting the department of psychiatry in a teaching hospital in Southern India and their association with various clinical and sociodemographic factors in them. The index study was a descriptive cross-sectional study involving consenting adults who presented to the department of psychiatry with mental disorders from August 2013 to January 2014. Socio-demographic and clinical data were collected using a semi-structured proforma, and the Discrimination and Stigma Scale (DISC-12) was used to assess discrimination and stigma. Most of PMI suffered from bipolar disorder, followed by depression, schizophrenia, and other disorders, such as obsessive-compulsive disorder, somatoform disorder, and substance use disorder. Discrimination was experienced by 56% of them and 46% had stigmatizing experiences. Both discrimination and stigma were found to be significantly associated with their age, gender, education, occupation, place of residence, and illness duration. While PMI suffering from depression experienced the highest discrimination, those with schizophrenia faced the stronger stigma. Binary logistic regression revealed depression, family history of psychiatric illness, age of less than 45 years, and rural locality of residence to be the significant determinants of discrimination and stigma. The study thus found that stigma and discrimination were associated with multiple social, demographic, and clinical factors in PMI. A rights-based approach to PMI is the need of the hour to tackle stigma and discrimination, which is already included in recent Indian acts and statutes. Implementation of these approaches is the need of the hour.

"SILENT": A case report of a rare syndromal presentation of chronic lithium toxicity.

This text discusses a case report of an affected person with bipolar ailment who developed the syndrome of irreversible lithium effectuated neurotoxicity (SILENT). In this case of a 62-year-old man with bipolar affective disorder, we found how continual lithium therapy can position a patient requiring chronic mood stabilizer treatment vulnerable to developing the silent syndrome. The case presentation covered a set of symptoms inclusive of encephalopathy, cerebellar dysfunction, stress, and limb tremors at the time of admission. A serial neurological examination and mental status examination for ascertaining the diagnosis of the silent syndrome were carried out, and the affected person was advised to discontinue lithium and was handled symptomatically for other symptoms. We ought to identify and manage the hazard elements contributing to the development of this syndrome.

Aripiprazole-induced obsessive-compulsive symptoms.

Aripiprazole is a novel antipsychotic with a unique pharmacological profile as a dopamine partial agonist. It is indicated for treatment of schizophrenia and bipolar disorder. This new antipsychotic has low rate of extrapyramidal side effects, metabolic changes and no significant adverse effect on serum prolactin concentration. In addition,it is not associated with significant weight gain like other atypical antipsychotics. As a reason, when other antipsychotics cause these adverse events, it's not uncommon to switch to Aripiprazole. Obsessive compulsive symptoms have been untoward sequel of a few second-generation antipsychotics. Among the second generation antipsychotics Clozapine, Olanzapine, and Risperidone are the most prominent agents associated with these sequelae, according to case reports. More recently, a handful of case reports indicated development of Obsessive-compulsive symptoms with Aripiprazole. We report a case that exhibited similar unexpected adverse effects after administration of Aripiprazole. Keywords: Aripiprazole, Second generation antipsychotics, Obsessive-compulsive symptoms (OCS).

Serum and salivary immunoglobulin G4 levels in children with autism spectrum disorder from south India: a case-control study.

BACKGROUND: Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder with wide spectrum of symptoms and few effective therapies. Evidence is suggestive of an association between immune system dysfunction and autism spectrum disorders (ASD) among children with ASD. Immunoglobulins (Ig) are found to be increased in the circulation of individuals with autism. The prospective study was aimed to estimate and correlate the levels of IgG4 in blood and saliva of children with autism. METHODOLOGY: Blood and unstimulated saliva were collected from 172 children (55 ASD, 57 healthy control, and 60 suspected parasitic infection) aged 0-18 years. Routine blood investigations were done. Serum and salivary IgG4 levels were analyzed using a commercially available enzyme-linked immunosorbent assay (ELISA) kit. Data were subjected to statistical analysis. RESULTS: ELISA tests showed that the IgG4 levels in serum and saliva were significantly increased (P<0.05) in children with ASD as compared to normal control children. Both serum and saliva IgG4 levels showed a significant positive correlation (P<0.05). CONCLUSION: IgG4 can be used as a potential biomarker for the early detection of ASD. Further, saliva can be a diagnostic, noninvasive assessment tool for health monitoring of children with autism. Lay summary: The collection of saliva is easy and painless compared to other sample collection methods. The present study shows that, among children with autism, brain-reactive antibody, immunoglobulin G4 (gG4), is increased both in blood and saliva, and there is a significant correlation between the two levels. Therefore, the study recommends IgG4 as a potential biomarker for the early detection of autism, and saliva can be helpful in diagnosis and health monitoring of children with ASD.

Folie a deux in monozygotic twins with childhood trauma: A case report.

Folie a deux is a rare syndrome characterized by induction of a delusion in a susceptible person in close proximity with an individual with known delusional disorder. We report a rare case of monozygotic twins with induced delusional disorder in one of the twins. The twins had experienced childhood trauma in the form of emotional neglect and physical abuse by the father. The primary case (Twin A) was diagnosed with delusional disorder and was treated with oral antipsychotic. The secondary case (Twin B) showed resolution of symptoms after separation from twin A. The case highlights the unique presentation of induced delusional symptoms in monozygotic twins and the close association between childhood trauma and psychosis.

Comparison of maternal stress and psychiatric morbidity among mothers of children having psychiatric disorders and those of typically developing children.

INTRODUCTION: Motherhood is regarded to be stressful, but when the child has a psychiatric illness, the mother is affected more than the father since she is the primary caregiver. She gets affected not only emotionally but also psychologically. Increasing severity of stress in mothers may lead to negative outcome on a child's care. AIMS: The aim of this study was to evaluate the stress levels in mothers of children diagnosed with psychiatric disorder and to study the association between children having a psychiatric disorder and the psychiatric morbidity in their mothers. MATERIALS AND METHODS: This was a case-control study with a total of 150 participants, in which 75 consecutive mothers of children were diagnosed with any psychiatric illness using ICD-10 criteria and compared to 75 mothers of typically developing children. The study was approved by the Institutional Ethics Committee. The Parental Stress Scale and the Mini-International Neuropsychiatric Interview-Plus questionnaire were used for assessments. RESULTS: The study showed statistically significant stress scores (49.54) in mothers having children diagnosed with psychiatric illnesses as compared to scores (30.98) in mothers of normally developing children. Psychiatric morbidity in cases (n = 58; 77.3%) was statistically significant as compared to controls (n = 23; 30.6%). Depression and anxiety were among the most common psychiatric morbidities evaluated, and the highest was for mothers having children with severe mental retardation. CONCLUSION: In all children with psychiatric disorders, mothers have to be screened for psychiatric morbidity to prevent, detect, and manage it at the earliest.

Aspiration of hijab pin is sharply rising among young women---A preventable health problem.

INTRODUCTION: Foreign body aspiration is a common life threatening emergency but largely a preventable problem. There is an increase in the number of headscarf pin aspiration cases among young girls as a result of increase in the number of veiling population. With the number of hijab wearing population increasing all over the world, attention must be brought to the risk associated with holding the hijab pins in the mouth. AIM: To study the practice of holding hijab pin in the mouth among Muslim women. METHODS: In a first study of its kind, we interviewed 270 Muslim women with varied background to study the practice of hijab pin use and holding it in the mouth. RESULTS: Among 270 Muslim women, 260 (96.3%) of them wear hijab. 221 (81.85%) women use hijab pins to hold different layers of hijab. 191 (70.74%) of them hold the hijab pins in between the lips when they adjust the layers of hijab. 72 (26.67%) women had occasions when the hijab pin slipped into their mouth and 10 (3.70%) of them have aspirated the hijab pin accidentally. Maximum hijab pin use is in the age group between 21 and 40 years (89.44%) and least in the elderly (6.66%). Occasions when the pin slipped into the mouth or aspirations both are maximum in the below 20 years group. Both are nil in elderly. CONCLUSION: Appropriate education and intervention need to be planned as more young population are getting involved. Most importantly refrain from holding the pin in the mouth!

Prevalence of depressive disorders among head-and-neck cancer patients: A hospital-based, cross-sectional study.

BACKGROUND: Head-and-neck cancers (HNCs) are associated with significant psychosocial challenges at all stages of illness, which influence the course and outcome of cancer. We aimed to assess the prevalence of depressive disorders among patients with HNC and its sociodemographic and clinical determinants. MATERIALS AND METHODS: It was a cross-sectional study conducted in the department of oncology of a medical college hospital from South India. A total of 100 adult patients with HNC were recruited over a period of 1 year, after obtaining ethical clearance. Mini International Neuropsychiatric Interview was used to assess for depressive disorders in these patients. RESULTS: We found that 49% of the patients were suffering from major depressive disorder (MDD), 13% of the patients had MDD with melancholic features, and 10% had dysthymia. Functional impairment and surgical treatments were associated with the diagnosis of depressive disorders. CONCLUSION: Depressive disorders are highly prevalent in HNC and emphasize the need for tailored psycho-oncological and psychotherapeutic interventions.

Valproate: It's Effects on Hair.

Valproate is a drug used in the treatment of various seizure disorders, bipolar disorder, migraine prophylaxis, and off label in many indications by various specialists. The common adverse drug reactions reported on valproate administration are tremor, weight gain, gastrointestinal disturbances, liver dysfunction, metabolic acidosis, thrombocytopenia, and hair loss. An internet search with keywords "valproate" and "hair" was done on Google Search and PubMed for articles related to the topic. Recognition of cosmetically significant side effects on hair is necessary and neglect of which might result in poor compliance. Valproate-induced hair loss is diffused, nonscarring, and dose related. Other hair-related adverse events are curling of hair, graying, dirty appearance, and changes in texture. In contrast to oral ingestions causing hair loss, experiments with topical valproic acid have shown some initial evidence on hair regeneration. This makes valproate's effects on hair interesting and understanding it's effects on hair is very much essential in clinical practice.

Drinking pattern in persons with alcohol dependence with and without cirrhosis: A hospital-based comparative study.

BACKGROUND: Worldwide, alcohol is the most frequently used and socially accepted hepatotoxin. However, not everyone who has alcohol dependence develops alcoholic cirrhosis, and does quantity/type or pattern of alcohol intake determine the development of cirrhosis? A study of this nature would help in delineating similarities/differences in the drinking pattern between alcohol dependence and alcohol-induced cirrhosis groups. AIM: The aim was to study the drinking pattern of persons with alcohol dependence syndrome (ADS) and alcohol-induced cirrhosis. MATERIALS AND METHODS: Alcohol Intake database and Severity of Alcohol Dependence Questionnaire (SADQ) were administered to eighty male inpatients with a reliable family member of which forty were in ADS group and forty were in alcohol dependence with cirrhosis group. RESULTS: Persons in the cirrhosis group were older with longer duration of drinking. There is no statistically significant difference in the educational status, religion, occupation, socioeconomic class, mean age of onset of drinking, mean age of development of dependence, type of beverage preferred, and initiating/maintaining factors between the two groups. The amount of alcohol consumed was significantly high in the cirrhosis group, with 33.5% in the high severity of dependence. They usually were drinking alone, outside meal times with regular and intermittent binge pattern. CONCLUSION: Alcohol dependence and alcohol-induced cirrhosis may be on a continuum but form a different group of heavy drinkers who may require different approaches to management.

Sensory Gating Deficits and their Clinical Correlates in Drug-Free/Drug-Naive Patients with Schizophrenia.

BACKGROUND: Sensory gating refers to "filtering" of irrelevant sensory input in the brain. Auditory sensory gating deficit has been considered as a marker of schizophrenia (SCZ) and assessed using P50 paired-click paradigm. We explore sensory gating deficits and their clinical correlates in SCZ. MATERIALS AND METHODS: Twenty-five drug-free/drug-naïve patients with SCZ, whose psychopathology was assessed using Positive and Negative Syndrome Scale (PANSS), and 25 age-matched normal controls (NC) were recruited. ERP recordings were done using 40-channel event-related potential measuring system. RESULTS: S2-S1 P50 amplitude difference, an index of sensory gating, was significantly lower in SCZ at F3 and F4 sites when compared to NC, indicating impaired gating. SCZ had significantly lower S1 amplitude compared to NC at these sites; S2 amplitudes were comparable. The sensory gating index also showed significant correlations with PANSS scores. CONCLUSIONS: Our study reiterates sensory gating abnormalities in SCZ and confers a frontal specificity, implying specific deficits in early preattentive processes to them. Further, we suggest that gating deficits in SCZ are driven predominantly by abnormally small S1 rather than an inability to suppress S2. A correlation between sensory gating parameters and measures of psychopathology strengthens the hypothesis that abnormal response to sensory input may contribute to the psychopathology in SCZ.

Facebook addiction and loneliness in the post-graduate students of a university in southern India.

BACKGROUND: Facebook is a social networking site (SNS) for communication, entertainment and information exchange. Recent research has shown that excessive use of Facebook can result in addictive behavior in some individuals. AIM: To assess the patterns of Facebook use in post-graduate students of Yenepoya University and evaluate its association with loneliness. METHODS: A cross-sectional study was done to evaluate 100 post-graduate students of Yenepoya University using Bergen Facebook Addiction Scale (BFAS) and University of California and Los Angeles (UCLA) loneliness scale version 3. Descriptive statistics were applied. Pearson's bivariate correlation was done to see the relationship between severity of Facebook addiction and the experience of loneliness. RESULTS: More than one-fourth (26%) of the study participants had Facebook addiction and 33% had a possibility of Facebook addiction. There was a significant positive correlation between severity of Facebook addiction and extent of experience of loneliness ( r = .239, p = .017). CONCLUSION: With the rapid growth of popularity and user-base of Facebook, a significant portion of the individuals are susceptible to develop addictive behaviors related to Facebook use. Loneliness is a factor which influences addiction to Facebook.