In-vivo Analgesic and In-vitro Cytoprotective Potential of Various Leaf Extracts of Pongamia pinnata

Pongamia pinnata (L.) Pierre is a medium sized glabrous, perennial tree which grows in the littoral regions of South Eastern Asia and Australia. In the Indian Ayurvedic medicine, different parts of the plant have been used for pain relief in various disorders. The present study investigated the potential of different leaf extracts of Pongamia pinnata as an analgesic agent in rodents and our aim was also to study in-vitro cytoprotective effects of the various extracts from leaves of the plant. Different leaf extracts of Pongamia pinnata i.e. aqueous, alcoholic, acetone and chloroform were investigated for analgesic activity at the dose rate of 50 mg/kg and 100 mg/kg in Wistar rats. For the assessment of analgesic activity, tail flick method was used. In-vitro cytoprotective activity of various leaf extracts (at concentrations of 5% and 10%) was evaluated in ATCC acquired MDBK cell lines and for this study, cytotoxicity was induced by thiomethoxam. It was observed that almost all the extracts demonstrated the dose dependent analgesic activity with maximum response in the aqueous extract group @ 100 mg/kg when compared to control. For cytoprotective study, oxidative stress parameters- catalase, LPO, SOD and GPx were determined. Study on analgesic activity revealed the presence of dose dependent effect in all extracts with highest effect in aqueous extract of Pongamia pinnata. We believe that triterpene alkaloids and steroidal principles present in the plant products might be responsible for the analgesic effect

Prevalence of Mood and Anxiety Disorders in Opioid Addicts.

Introduction: Substance use disorders and mood and anxiety disorders are widespread among the general population. Methods: This study assessed the rate of current mood disorders and anxiety disorders in outdoor opioid addicts. The data were collected from five hundred opioiddependent patients who were seeking treatment from outdoor dept. of civil hospital, Gurdaspur. The Research version of structured clinical interview for DSM-IV Axis I Disorders was used. Results: The majority (23%) were self employed and 20% were unemployed. 25% had education till the level of high school, 15% were illiterate. 326(65.2%) subjects were diagnosed as having mood disorders, of those 274 (29%) had substance induced depression, 41 (8.2%) had major depression, 5 (1%) had dysthymia, 5 (1%) bipolar mood disorder type I, and 2 (0.4%) were diagnosed as having bipolar mood disorder type II. 138 (27.6%) subjects were diagnosed as having substance-induced anxiety disorders, and 88 (17.6%) as having generalized anxiety disorder. Of the participants 218 (43.6%) reported more than 5 years use of opioid abuse. Conclusions: Due to high rates of mood disorders in opioid-dependent subjects, psychiatric treatment services should be open and accessible to the patients, especially those who voluntarily seek help and treatment to reduce the rate of mood disorders and reduce relapse of substance abuse also.

A Comparison of Clinical Features among Patients Suffering from Depression in HIV Positive and HIV Negative Cases.

Background: Depression is common in patients with HIV/AIDS, and its identification and treatment are critically important in disease management. HIV positive individuals have a estimated prevalence rate of depression about 22% - 45% compared with 15% of general population. This study compared the clinical features of major depressive disorder between HIV-Positive and HIV-negative patients with a view to intervention strategies. Method: A comparative, descriptive, cross-sectional study was carried out on 50 HIV-Positive depressed patients and 50 HIV-negative depressed patients in ICTC centre of Civil hospital, Gurdaspur. They were compared along the parameters of clinical features of depression and physical examination. Results: Compared to HIV-Negative patients, HIV positive patients were more likely to have a medical illness and taking medication before onset of depression, symptomatically compared to HIV-Negative patients. HIV-Positive patients had poorer sleep, felt more easily tired, more appetite changes, more suicidal ideation. Conclusion: These findings show that the clinical and associated features of depression differ between HIV-Positive and HIV-Negative patients, thus requiring different management approaches and further studies related to HIV-related depression.

Safety and Efficacy of Add on Modafinil to Selective Serotonin Reuptake Inhibitors in Major Depressive Disorder.

Aim: Despite the efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment of major depression, a significant number of patients show partial or no remission of symptoms. Although antidepressant medications are effective, they have a delayed onset of therapeutic effect. Modafinil is a novel psychostimulant that may be helpful in treating patients with residual symptoms of depression. The efficacy of modafinil as add-on therapy to SSRIs in depressed patients in Indian population is lacking; hence this study was designed to study the efficacy and safety of Modafinil as add-on therapy to SSRI in depressed patient in Indian Population.Methods: In an open, randomized study, 50 patients diagnosed with major depressive disorder (MDD) were divided into two groups. In Group A (n = 25) patients received conventional SSRIs with low dose Modafinil for 8 weeks. In Group B (n = 25) patients received conventional SSRIs for 8 weeks. Patients were evaluated at baseline and then at the end of 2, 4, 6, and 8 weeks. Results: There was significant improvement in Hamilton depression rating scale (HDRS), Epworth Sleepiness Scale (ESS), Fatigue severity Scale (FSS) and Clinical Global Improvement – severity (CGI-S) Scale (p < 0.05) in both groups. Modafinil in low dose as add on therapy showed more decrease in scores, had earlier onset of action, as compared to conventional treatment (p < 0.05). No serious adverse event was reported in either of the groups. Conclusion: Low dose Modafinil as add-on therapy had shown better efficacy, earlier onset of action as compared to conventional treatment in MDD in Indian patients.

A Case Control Study to Assess the Comorbidity of Depression and Migraine.

Background — Migraine is a common neurological disorder affecting around 18% of females and 6% of males. The present study was undertaken to identify and assess the impact of coexisting depression in diagnosed cases of migraine. Material and Methods — A hospital based case control study was conducted on 450 patients suffering from migraine of all ages and both sexes attending psychiatry OPD at civil hospital, Gurdaspur in Punjab. International headache society criteria for the diagnosis of migraine and 21- item Hamilton rating scale for depression was used. Migraine with depression (MWD) cases were compared with migraine without depression as controls (MC). Duration and frequency of migraine, comorbidity with depression was measured. Results — Out of 450 patients, 200 were MWD and 200 were MC patients. Among MWD and MC, females were common: 73% (146) and 75% (150) respectively. Of the females having MWD, 50% (73) belonged to age group 31-40 years as compared to females with MC where 58% (87) were from age group 21-30 years. Among the males, maximum number of patients belonged to age group 20-30 years for MWD and MC i.e 48% ( 26 ) and 57% (29) respectively. 50% of MWD reported having migraine attacks for five years or more years, whereas only 16% of MC had the similar duration (P value<0.01). 80% of (n=160) of MWD reported maximum disability during the headache as compared to 64% (n=128) of MC. 70% (140) of MWD had an average frequency of 4 or more attacks per month compared to 45% (90) of MC having one episode per month or less. Conclusion — Patients suffering from migraine with long history and high frequency might benefit from psychiatric evaluation and addition of antidepressants for their treatment.

Attitudes of Family Members Towards Mentally Handicapped Children and Family Burden.

Background — The burden associated with rearing such mentally handicapped children usually affects whole of atmosphere of home including routine family life, emotional aspects and financial resources of family. The present study has been undertaken with the aim of determining the attitudes of family members towards a mentally handicapped child in their family and it has been assessed whether such children are considered as burden to their families. Material and Methods — The study was carried out in psychiatry OPD of the civil hospital, Gurdaspur in Punjab. Parents of children suffering from mental handicap who came for getting mental disability certificate for their children were included in the study. Total 200 families of mentally handicapped children were included in age group of upto 16 years of age. They were interviewed using a questionnaire based on ‘ Questionnaire on Resources and stress ‘scale to measure burden in their families. During the interview, an attempt was made to have both the parents present. Results — Basic psychometric properties of the questionnaire were sound. Findings revealed that mean burden was minimal to moderate in all the 200 families. The intelligence quotient was between 36 and 51 in 120 children, 70 children had IQ between 20 and 35, 10 children had IQ below 20. The education of parents was upto 5th standard in 100 children, upto 8th standard in 80 children, upto12th standard in 15 children and upto graduation in 5 children. 80% of families belonged to poor socioeconomic status. 10% of families belonged to middle class background. Conclusion — Our findings support the fact that children suffering from mental handicap are considered as burden by their family members. Negative parental attitude leads to rejecting attitude towards mentally retarded children. This adversely affects the interaction within the family and also with outsiders. Such children should be offered support by family members to enable them to cope with stressful situations and in their rehabilitation. There is a need for implementation of family based schemes for such disabled children.

Comparison of Intramuscular Olanzapine and Intramuscular Haloperidol in Treatment of Acute Agitation in Patients of Schizophrenia.

Objectives: To determine the antipsychotic efficacy and extra pyramidal safety of intramuscular olanzapine and intramuscular haloperidol during the first 24 hours of treatment of acute agitation in schizophrenia. Methods: Patients (n = 29) with schizophrenia were randomly allocated to receive one to three injections of intramuscular olanzapine (10 mg, n =14), intramuscular haloperidol (10 mg, n = 14) over a 24-hour period. Agitation was measured with the excited component of the positive and negative symptom scale (PANSS) and agitation behavior scale (ABS). Results: After the first injection, IM olanzapine was comparable to IM haloperidol for reducing mean changes in scores from baseline on excited component of PANSS at 2 hours to ( -13.08 olanzapine, -8.07 haloperidol ) and at 24 hours (-9.86 olanzapine, -8.07 haloperidol ). Mean changes in the scores of ABS scale from baseline was at 2 hours (-9.78 olanzapine, -8.54 haloperidol) and at 24 hours (-6.14 olanzapine, -6.6 haloperidol). Patients treated with IM olanzapine had significantly fewer incidence of treatment emergent Parkinsonism (0% olanzapine versus 6.66% haloperidol, p = 4.55), no patient had akathisia with olanzapine as compared to 13.33% of patients with haloperidol, p = 2.03. No patient developed acute dystonia compared to 6.66% of patients with haloperidol, p = 2.59. Conclusion: IM olanzapine was comparable to IM haloperidol in reduction of symptoms of acute agitation in schizophrenia during first 24 hours of treatment, the efficacy of both being evident within 2 hours after first injection. More Extra pyramidal symptoms were observed during treatment with IM haloperidol than with IM olanzapine.

Prevalence of Depression in Epileptic Patients.

Objectives : To determine the prevalence of depression among epileptic patients attending the outdoor patient department of Psychiatry department of G.G.S. Medical College, Faridkot. Material and Methods: Total 100 consecutive epileptic patients were included in study , these patients were screened with ICD-10 diagnostic criteria of depression and were interviewed. Demographic data that affect depression were evaluated. Results: During the study of 100 patients, prevalence of depression was 25%. Mild depression was found in 67% and moderate in 33%. No patient had severe depression . Comparing between male and female patients, there was no statistical significant diference (P>0.05). The age group that compared between age equal or less than 25 years and more than 25 years had no statistical significant difference (P>0.05). Other variables were not found to be significant risk factors of depression among epileptic patients including duration of seizures [Equal or less than 5 and more than 5 per year (P>0.05)] and number of antiepileptic drugs [monotherapy and polytherapy (P>0.05)]. Type of seizures [ Generalized tonic clonic seizures and Partial seizures had statistical significant difference ( P<0.05)]. Conclusion: Prevalence of depression among epileptic patients was 25%, divided between mild (67%) and moderate (33%) . Epileptics should be aware of this and seek prompt treatment for depression.

An Open Label Study on Amisulpride in Augmentation with Atypical Antipsychotics in Treatment Resistant Patients of Schizophrenia and Schizoaffective Disorders.

The authors report an open label study in treatment resistant patients of schizophrenia and schizoaffective disorders. The patients who were earlier being treated with atypical antipsychotics were put on combination of amisulpride and atypical antipsychotics and efficacy as well as safety of the combination was assessed. Method: A study of 6 weeks duration was conducted on 30 patients (9 women, 21 men).The mean dose of amisulpride used was from 250.00 mg/day + 91.65. SAPS, SANS, CGI-S scales were applied. 4 patients dropped out of study. 26 patients completed 6 weeks duration. Results: There was significant improvement in negative symptoms, positive symptoms, cognition especially in old chronic schizophrenics.Only two patients developed extrapyramidal symptoms.Improvement in all symptoms was remarkable. Conclusion: The combination of amisulpride with atypical antipsychotics is a promising option in patients who are resistant to treatment.