ABSTRACT
The 5,10-methylenetetrahydrofolate reductase (MTHFR) gene plays a central role in folate metabolism. Many studies have demonstrated an association between MTHFR C677 T variant with depression, schizophrenia and bipolar disorder as one of them being comorbid to other. This has justified the use of folate supplement in psychiatric disorders mainly depression but still not in various other comorbid complex psychiatric disorders. Here we have tried to show how the l-methylfolate in conjunction with the conventional psychotropic drugs can be useful in a state of such complex psychiatric phenomenon and comorbid diagnosis with genetic polymorphism of MTHFR C677 T mutation.
Subject(s)
Antidepressive Agents/pharmacology , Antipsychotic Agents/pharmacology , Bipolar Disorder/drug therapy , Depressive Disorder, Treatment-Resistant/drug therapy , Methylenetetrahydrofolate Reductase (NADPH2)/genetics , Obsessive-Compulsive Disorder/drug therapy , Tetrahydrofolates/pharmacology , Vitamin B Complex/pharmacology , Adult , Antidepressive Agents/administration & dosage , Antipsychotic Agents/administration & dosage , Aripiprazole/administration & dosage , Aripiprazole/pharmacology , Drug Therapy, Combination , Fluoxetine/administration & dosage , Fluoxetine/pharmacology , Humans , Lithium Compounds/administration & dosage , Lithium Compounds/pharmacology , Male , Polymorphism, Genetic , Tetrahydrofolates/administration & dosage , Vitamin B Complex/administration & dosageABSTRACT
The coincidence or causal incidence of hormonal dysregulation leading to psychotic manifestation had been a point of debate. The interplay of these hormones in pathogenesis of psychotic symptom domains is still inconclusive along with some symptom domains which worsen with antipsychotics. Early detection and treatment with liaison approach is of great help to such patients. We report a case of schizophrenia with primary hypogonadism that responded dramatically to add on testosterone supplement.
Subject(s)
Antipsychotic Agents/therapeutic use , Bites and Stings/complications , Hypogonadism/psychology , Schizophrenia/drug therapy , Testosterone/therapeutic use , Animals , Dogs , Drug Therapy, Combination , Humans , Hypogonadism/etiology , Male , Testis/injuries , Young AdultABSTRACT
Repetitive transcranial magnetic stimulation (rTMS) has emerged as a potential treatment in treatment resistant major depressive disorder (MDD). However, there is no consensus about the exact site of stimulation for rTMS. Single-photon emission computed tomography (SPECT) offers a potential technique in deciding the site of stimulation. The present study was conducted to assess the difference in outcome of brain SPECT assisted rTMS versus standard protocol of twenty sessions of high frequency rTMS as add on treatment in 20 patients with treatment resistant MDD, given over a period of 4 weeks. Thirteen subjects (group I) received high frequency rTMS over an area of hypoperfusion in the prefrontal cortex, as identified on SPECT, whereas 7 subjects (group II) were administered rTMS in the left dorsoslateral prefrontal cortex (DLPFC) area. Improvement was monitored using standardized instruments. Patients in the group I showed a significantly better response compared to those in the group II. In group I, 46% of the subjects were responders on MADRS, 38% on BDI and 77% on CGI. The parallel figures of responders in Group II were 0% on MADRS, 14% on BDI and 43% on CGI. There were no remitters in the study. No significant untoward side effects were noticed. The study had limitations of a small sample size and non-controlled design, and all the subjects were also receiving the standard antidepressant therapy. Administration of rTMS over brain SPECT specified area of hypoperfusion may have a better clinical outcome compared to the standard protocol.
Subject(s)
Depressive Disorder, Major/therapy , Depressive Disorder, Treatment-Resistant/therapy , Outcome Assessment, Health Care , Prefrontal Cortex/physiopathology , Tomography, Emission-Computed, Single-Photon/methods , Transcranial Magnetic Stimulation/methods , Adult , Female , Humans , Male , Middle AgedSubject(s)
Hospital Departments/statistics & numerical data , Length of Stay/statistics & numerical data , Mental Disorders/therapy , Mother-Child Relations , Tertiary Care Centers/statistics & numerical data , Adult , Child , Female , Hospital Departments/organization & administration , Humans , India , Retrospective Studies , Tertiary Care Centers/organization & administrationABSTRACT
Dissociative symptoms can be induced by a variety of conditions that can either coexist or mimic each other in clinical presentation. In coexisting dissociative disorder with medical illness, the causality remains uncertain, but sometime its role as nidus for dissociative symptoms just cannot be ruled out. The origin of "organic dissociative disorder" is undoubtedly found by various authors who demonstrated that a high percentage of patients with dissociative symptoms present with some form of neurological insult before developing the symptom. Herein we report on a case of adolescent onset hemi-parkinsonism with coexisting dissociative disorder.
Subject(s)
Dissociative Disorders/diagnosis , Parkinsonian Disorders/diagnosis , Adult , Age of Onset , Antiparkinson Agents/administration & dosage , Antiparkinson Agents/pharmacology , Carbidopa/administration & dosage , Carbidopa/pharmacology , Drug Combinations , Female , Humans , Levodopa/administration & dosage , Levodopa/pharmacology , Parkinsonian Disorders/drug therapy , Young AdultABSTRACT
Troublesome side-effects and lack of efficacy of the pharmacotherapy are the two major limitations in the depression treatment. Inspite of the established modalities like switching, combination and augmentation, using pharmacological and non-pharmacological agents, nearly one-third patients do not achieve complete remission. Repetitive Transcranial Magnetic Stimulation (rTMS) is one such somatic treatment which has been extensively studied for treatment for acute depression. Drop-out rates due to adverse effects have been found to be extremely low. However, literature regarding the role of rTMS in maintenance treatment in recurrent depression is scarce, and there is no existing literature from India. In this case-report we highlight the role of rTMS in the maintenance treatment of TRD in a patient who has been followed up for about three years (four episodes). Emphasis is placed on improvement in symptoms and functioning without use of any pharmacological treatment. Further, the need for systematic study and standardization of various aspects of rTMS therapy for maintenance treatment is emphasised.
