Effectiveness of neurofeedback training, behaviour management including attention enhancement training and medication in children with attention-deficit/hyperactivity disorder - A comparative follow up study.

BACKGROUND: Attention Deficit/ Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental psychiatric disorders of childhood. Treatment of ADHD includes medications and Behavioural interventions. Neurofeedback, a type of biofeedback, has been found to be useful in ADHD. It helps patients to control their brain waves consciously. However, it is not yet conclusive if it is efficacious in comparison to behavioural management training and medication. AIM: To compare the efficacy of neurofeedback training, behaviour management including attention enhancement training and medication in children with ADHD. METHOD: Ninety children between 6 and 12 years with ADHD were taken and randomly divided into 3 treatment groups equally- neurofeedback, behaviour management and medication (methylphenidate). Conners 3-P Short Scale was applied for baseline assessment. The respective interventions were given and follow up was done at the end of 3 months by using Conners 3-P Short scale to assess the improvement in the symptoms. There were 6 dropouts, the final sample size was 84. RESULTS: The medication group showed the greatest reduction of symptoms in inattention, hyperactivity, executive functioning domain (core symptoms of ADHD). No statistically significant difference was observed between Neurofeedback and Behaviour Management in these domains. Learning problems improved in all three groups, neurofeedback being the most effective followed by medication. Both Neurofeedback and Medication groups showed similar effect which was higher than the Behavioural Management group in Peer Relation. CONCLUSION: Improvement in core ADHD symptoms have been observed with all 3 interventions with medication showing the greatest improvement Neurofeedback has been superior for learning problems. Thus, Neurofeedback can be an independent or combined intervention tool for children with ADHD in outpatient department of Psychiatry.

Selective serotonin reuptake inhibitor-induced galactorrhea with hyperprolactinemia.

Galactorrhea in nonpregnant woman of child-bearing age is related to various pathologies including the use of psychotropic. Although common with antipsychotics, galactorrhea with antidepressants was infrequent. Previously reported cases of galactorrhea were mostly with combined antidepressants and cases of galactorrhea with paroxetine and fluvoxamine were with normal serum prolactin level. We reported three cases of galactorrhea, one with single use of paroxetine and other two with fluvoxamine with elevated serum prolactin level in all three cases.

Change of symptoms of schizophrenia across phases of menstrual cycle.

The relation between schizophrenia and the menstrual cycle has always been found attractive by researchers. It is still a question of debate whether the clinical picture changes during the menstrual cycle. Our study aimed to see whether there is any change of symptoms during different phases of menstrual cycle (premenstrual, menstrual, and postmenstrual) in patients suffering from schizophrenia. Over a period of 15 months, 40 female inpatients of a tertiary care psychiatric hospital with the diagnosis of schizophrenia were assessed by applying PANSS. Rating was done up to two menstrual cycles. Total scores, positive and negative subscale scores, and general psychopathology scores of PANSS in premenstrual, menstrual, and postmenstrual phases of those patients were compared with one another by applying paired t test. Symptoms in women suffering from schizophrenia frequently vary with the different phases of menstrual cycle. The positive symptoms improved significantly only during progesterone phase. Negative symptoms and general psychopathology subscale showed improvement on estrogen phases of menstrual cycle. So optimal treatment needs to be adjusted to the individual women suffering from schizophrenia.

Extrapyramidal side effects with low doses of amisulpride.

Amisulpride, the newly introduced antipsychotic in India, is claimed to be effective in both positive and negative symptom schizophrenia and related disorders, though it has little or no action on serotonergic receptors. Limbic selectivity and lower striatal dopaminergic receptor binding capacity causes very low incidence of EPS. But, in clinical practice, we are getting EPS with this drug even at lower doses. We have reported three cases of akathisia, acute dystonia, and drug-induced Parkinsonism with low doses of amisulpride. So, we should keep this side effect in mind when using amisulpride. In fact, more studies are required in our country to find out the incidence of EPS and other associated mechanism.

Correlation between lipid peroxidation-induced TBARS level and disease severity in obsessive-compulsive disorder.

Oxidative stress is thought to play an important role in several neuropsychiatric diseases including obsessive-compulsive disorder (OCD). Thiobarbituric acid reacting substances (TBARS) are products formed as a result of free radical induced lipid peroxidation in the human body. Our study investigated the correlation between TBARS and the clinical severity of OCD as indicated by the Yale Brown Obsessive Compulsive Scale (YBOCS). Serum TBARS was estimated in thirty nine newly diagnosed drug free OCD patients and thirty three disease free control subjects. Mean values for serum TBARS were found to be significantly higher (P < 0.001) in cases than in controls (5.85 nmol/ml and 3.90 nmol/ml with an SD of 0.56 and 0.81 respectively). A strong positive correlation (rs = 0.757, p < 0.01) between the lipid peroxidation marker TBARS and the disease severity indicator YBOCS was found among cases. Significant positive correlation was also found between TBARS and the obsessive and compulsive subscales of YBOCS. These findings were in tune with previous studies, which suggested oxidative stress induced increased free radical generation in the OCD patients. Our findings may help in understanding the development and progress of OCD and the treatment of patients of OCD in future.

Study of oxidative stress in obsessive compulsive disorder in response to treatment with Fluoxetine.

Oxidative stress has been found to play important role in several neuropsychiatric diseases including Obsessive Compulsive Disorder. A longitudinal case control study was conducted to evaluate the oxidative stress in 30 newly diagnosed obsessive compulsive disorder patients and same number of control patients. Serum thiobarbituric acid reacting substances, plasma ascorbate were assessed to evaluate oxidative stress and Yale Brown obsessive compulsive scale for disease severity before and after treatment with Fluoxetine at the average dosage of 40 mg/day. Improvement in Yale Brown obsessive compulsive scale score by about 43% after 12 weeks treatment was associated with significantly decreased thiobarbituric acid reacting substances and increased plasma ascorbate values (p < 0.05). The newly diagnosed obsessive compulsive disorder patients had higher serum thiobarbituric acid reacting substances as well as a lower plasma ascorbate levels than the control population. Thus, the present study suggested a significant role of oxidative stress in obsessive compulsive disorder and showed that a successful treatment with Fluoxetine not only improves the clinical scenario but also reduces the oxidative stress that may further improve the prognosis of the disease.

Neurocognitive impairment in early HIV-positive individuals.

The study was carried out to find out the cognitive impairment if any, in early stages of human immunodeficiency virus-positive patients and if there is any cognitive impairment, then its association with duration of illness detection. Fifty patients with early stages of HIV and 50 matched controls were compared in various neuropsychological tests along with demographic profiles. Seropositive patients had poorly performed in digit symbol substitution test, trail making test and controlled word association test. This impairment had no association with duration of detection of illness. It is not known whether mild neurocognitive disorder predisposes patients to the development of frank dementia. Cognitive impairment should be identified early in order to maximise functional status, enhance quality of life and survival time.