Cingulum bundle integrity in schizophrenia with auditory verbal hallucinations: A diffusion tensor imaging tractographic study.

Background & objectives: Cingulum bundle (CB) is frequently implicated in schizophrenia; however, its role in specific symptoms of schizophrenia such as auditory verbal hallucinations (AVHs) is less explored. Few studies have reported association between reduced integrity of CB and severity of AVH. Using a symptom-based approach, this diffusion tensor imaging (DTI) tractographic study was aimed to assess and compare the integrity of CB in schizophrenia with AVH, schizophrenia without AVH and healthy controls. Methods: A total of 92 right-handed adult individuals (aged 18-50 yr) were recruited across three study groups. Those with Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) diagnosis of schizophrenia with AVH (group I; n=30) were compared to those with DSM-5 schizophrenia without lifetime AVH (group II; n=32) and healthy controls (group III; n=30; screened using Mini International Neuropsychiatric Interview version-7.0.0. and negative family history). Clinical assessments (groups I and II) included scale for assessment of positive symptoms, scale for assessment of negative symptoms, clinical global impression-schizophrenia and psychotic symptom rating scale. All participants underwent DTI, and quantitative tract-based measurements of fractional anisotropy (FA) were obtained for images using DTI studio version-3.0. Results: All groups were comparable for age, gender, education and severity of illness. Group I had significantly lower FA values in the cingulate gyrus (CG) part of the left CB compared to groups II and III. No significant difference was found between groups II and III. Interpretation & conclusions: The findings of this study suggest that the disruption in the left CB appears to be specific for AVH-positive schizophrenia. The finding is, however, preliminary subject to replication in future studies. Further investigations are needed to understand its relevance in the context of AVH-positive schizophrenia.

Prevalence and predictors of family accommodation in obsessive-compulsive disorder in an Indian setting.

BACKGROUND: Family accommodation (FA) is a phenomenon whereby caregivers assist/facilitate rituals or behaviors related to obsessive-compulsive disorder (OCD). FA, however, has been explored primarily in the Western population, and it is unclear to what extent it might be present in diverse cultural settings. At present, little is known about the extent and predictors of FA among caregivers of adult OCD patients in India. AIMS: The study aims to assess the extent, clinical correlates, and predictors of FA in the caregivers of adults with OCD. SETTINGS AND DESIGN: Cross-sectional study conducted in an outpatient setting in a tertiary-care hospital. MATERIALS AND METHODS: Hundred and one adult patients of either gender with Diagnostic and Statistical Manual of Mental Disorders-5 diagnosis of OCD and 101 caregivers were included. The patients were assessed using Yale-Brown Obsessive Compulsive Scale (YBOCS), Hamilton Rating Scale for Depression (HAM-D), World Health Organization Disability Assessment Schedule Version 2.0 12-item version (WHO-DAS 2.0.12), Clinical Global Impressions Scale for Severity (CGI-S), and Clinical Global Impressions Scale for Improvement. The FA Scale-Self Rated Version (FAS-SR) was applied on caregivers after Hindi translation. STATISTICAL ANALYSIS: Descriptive statistics, group comparisons, and Pearson's product moment correlations were carried out. Multiple linear regression modeling was performed with the total FAS-SR score as the dependent variable. RESULTS: About 92% of caregivers displayed at least some form of FA. Higher scores on HAM-D, YBOCS, WHODAS, and CGI-S were associated with higher scores on FAS-SR scale, which reached statistical significance (P < 0.01). CONCLUSIONS: FA in OCD appears to be a frequent phenomenon. Higher FA is associated with higher symptom severity and disability, emphasizing its clinical and research relevance for future studies.

Beliefs about voices and their relation to severity of psychosis in chronic schizophrenia patients.

BACKGROUND: Auditory hallucinations may persist in a subset of chronic psychotic patients in spite of treatment. It is important to understand the personal meaning and significance of voices in these patients. In spite of its relevance, only a limited literature is available. AIM: This exploratory study aimed to assess the beliefs regarding voices in treatment-seeking patients with chronic schizophrenia having persistent auditory verbal hallucinations (AVHs) and assess their relation to the severity of psychosis. MATERIALS AND METHODS: We recruited thirty adult patients with chronic schizophrenia as per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition with both lifetime and current significant AVHs (≥50% days/month). Co-occurring psychiatric disorders were ruled out using the Mini International Neuropsychiatric Interview-7.0.0. Patients were assessed using a semi-structured proforma, Beliefs about Voices Questionnaire-Revised (BAVQ-R), Psychotic Symptom Rating Scale (PSYRATS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), and Clinical Global Impression-Schizophrenia (CGI-SCH)-severity. RESULTS: The median age of the patients was 32 years (interquartile range [IQR]: 23.8-40.5). The median duration of illness and treatment was 7 years (IQR: 3.4-15.0) and 3 years (IQR: 1.9-10.5), respectively. Higher BAVQ-R scores were found on "malevolence," "omnipotence," and "emotional and behavioral resistance." These beliefs had a significant positive correlation with PSYRATS hallucination subscale, but not with the severity of psychosis (SAPS, SANS, and CGI-SCH). The sample had lower scores for "benevolence" and "engagement" subscales of BAV-Q. CONCLUSION: Overall, the study sample believed AVH to be more malicious and omnipotent rather than benevolent, and resisted the voices, engaging only minimally with them. These beliefs were not related to the severity of psychosis, but were related to the severity of hallucinations. Assessing the beliefs regarding AVH in larger, diverse samples may help to plan behavioral interventions.

Brain neurochemistry in unmedicated obsessive-compulsive disorder patients and effects of 12-week escitalopram treatment: 1 H-magnetic resonance spectroscopy study.

AIM: The purpose of this study was to examine treatment-related neurochemical changes in 28 unmedicated obsessive-compulsive disorder (OCD) patients using 1 H-magnetic resonance spectroscopy (1 H-MRS). METHODS: We included subjects diagnosed with OCD (n = 28), each with a total duration of illness of less than 5 years, as a study group and age- and sex-matched healthy controls (n = 26). The inclusion criteria for the OCD group were right-handed individuals aged 18 years or older who had not been on any specific treatment for OCD for the last at least 8 weeks and who had no other psychiatric comorbidity. A pre-post and case-control design was employed in which OCD patients underwent 1 H-MRS at baseline and 12 weeks after treatment with escitalopram (n = 21). Clinical assessment was carried out using a semi-structured pro forma Yale-Brown Obsessive Compulsive Scale and the World Health Organization Disability Assessment Scale 2.0 before and after treatment. Volume-localized 1 H-MRS was carried out with a 3-Tesla Philips MR scanner. RESULTS: Our data suggested higher levels of myoinositol (mI), total choline (tCho), and glutamate+glutamine (Glx) in the medial thalamus at pre-assessment in OCD subjects as compared to healthy controls and a significant reduction in tCho and Glx after treatment in OCD subjects. The mI levels in the caudate nucleus and Glx levels in the anterior cingulate cortex were significantly correlated with disease severity on the Yale-Brown Obsessive Compulsive Scale. CONCLUSION: Our study supports the hypothesis of a hyper-glutaminergic state (as suggested by increased Glx levels) and neurodegeneration (as suggested by increased tCho and mI in the thalamus) in cortico-striato-thalamocortical circuitry in OCD patients as suggested by previous studies using MRS as well as other functional imaging studies.

Examining the psychometric properties of the Hindi version of Family Accommodation Scale-Self-Report (FAS-SR).

CONTEXT: Family accommodation (FA) is the phenomenon whereby caregivers assist or facilitate rituals or behaviours related to obsessive compulsive disorder (OCD). There is a need for a self-rated instrument to assess this construct in resource-strained clinical settings of India. AIM: To explore the factor structure of Hindi version of Family Accommodation Scale-Self Rated version (FAS-SR) and compare its validity with the gold standard Family Accommodation Scale-Interviewer Rated (FAS-IR) scale. MATERIAL & METHODS: The Hindi version of FAS-SR scale and FAS-IR scale was applied on 105 caregivers of patients with OCD. RESULTS: The initial factor analysis yielded three-factor models with an eigenvalue of >1 and the total variance explained by these factors was 72.017%. The internal consistency of the 19-item scale was 0.93 indicating good inter-item correlation. There was a significant positive correlation between FAS-IR scale total score and all the factors of the FAS-SR Scale. The average measure ICC was 0.889 with a 95% confidence interval from 0.783 to 0.981 (F (62,84)=37.547, p<001) indicating high degree of reliability between the Hindi version of FAS-SR and the FAS-IR scale. CONCLUSIONS: FAS-SR is a practical alternative to FAS-IR and has the potential to be used widely in an Indian setting.

Delusion of Triplet Pregnancy in Abdominal Cavity: A Case Report with a Review of Literature.

The two terms, pseudocyesis and delusion of pregnancy, were frequently used for pseudopregnancy. Delusion of pregnancy is a special form of hypochondriacal/somatic delusion reported in various psychiatric and organic disorders. The origin of the delusion of pregnancy in schizophrenia has often been explained by psycho-analytic interpretations attributing wish fulfilling, protective role to false beliefs, and mother establishes an undisturbed union with her fetus during pregnancy, which eliminate loneliness and helplessness. The current case is a 49-year-old married female with an illness of total duration of 10 years. Initial symptoms were delusion of infidelity and persecution and 2nd and 3rd person auditory hallucination; however, the patient started reporting around 2 years back that she was pregnant and there were three female children inside her abdominal cavity rather than in uterus. She was firm on this belief and was not convinced by family members even giving evidence contrary to her belief like showing ultrasonography report. She firmly believed that these are gift of God, and they are special children who would be delivered through special procedure. Blood investigation revealed raised prolactin level, blood sugar and ultra sonography suggestive of cholelithisis. Patient's psychiatric symptoms including delusion of pregnancy were significantly improved with treatment, and medical and surgical comorbidities were managed with appropriate consultations.

Chlorpromazine as Prophylaxis for Bipolar Disorder with Treatment- and Electroconvulsive Therapy-Refractory Mania: Old Horse, New Trick.

A 22-year-old male diagnosed with bipolar affective disorder presented to us with a 3rd episode mania resistant to both olanzapine and haloperidol as well as electroconvulsive therapy. He, however, responded to chlorpromazine (CPZ) which was also effective as a mood stabilizer. The patient had a relapse of his illness when CPZ was stopped and responded again when it was started. The case demonstrates that CPZ may have a role in as both an anti-manic agent and for the maintenance for bipolar disorders. The possible underlying mechanism for this role is also discussed.

Multiple Meningioma in a Patient of Bipolar Disorder: The Dilemma of Detecting Structural Brain Lesions in the Backdrop of a Long Standing Psychiatric Illness.

Multiple meningioma often can be clinically silent and may present with only psychiatric symptoms. We report a case of 43-year-old, right handed woman with a 23 year history of long standing bipolar affective disorder, who presented with a mixed episode with psychotic symptoms which did not respond to usual treatment and was further complicated with a different set of symptomatology. MRI brain revealed multiple dural based mass lesions identified to be multiple meningiomas. Patient's symptoms improved after gamma knife stereotactic radiosurgery for the multiple meningioma. Our finding illustrates the need to assess for brain lesions in presence of atypical symptoms, along with unresponsiveness to traditional management with psychotropic medications in patients with bipolar affective disorders.

Time Trends of Cannabis Use Among Treatment-seeking Individuals at Government De-addiction Centers Across India Over a Period of 7 Years.

BACKGROUND: Cannabis continues to be the most commonly used illicit psychoactive substance globally. The National Survey in India conducted in the year 2004 also reported it to be the most commonly used illicit substance in the country. Furthermore, it was reported to be the second most commonly used psychoactive substance by the treatment seekers at de-addiction centers in the country. OBJECTIVES: To assess time trends of cannabis use among treatment-seeking individuals at government de-addiction centers across India over a period of 7 years. MATERIALS AND METHODS: The study utilized data collected through Drug Abuse Monitoring System across India. The data of treatment seekers from de-addiction centers established under the Drug De-addiction Program, Ministry of Health and Family Welfare, Government of India and supported by the Ministry of Social Justice and Empowerment, Government of India (122 in number) across the country were analyzed. RESULTS: A total of 107,469 individuals sought treatment from government de-addiction centers over the 7 years (2007-2013) period. With the exception of an aberration for the year 2012, there has been a steady decline in the proportion of treatment seekers who are not current cannabis users. A significantly greater proportion (Chi-square: 586.30, df: 1, P < 0.001) of individuals with current cannabis use alone or along with tobacco (20.4%) tend to have a co-morbid psychiatric disorder as compared to treatment seekers with current use of substances other than cannabis (6.1%). CONCLUSIONS: It is important to focus on cannabis in clinical service delivery and research in the country.

Ofloxacin induced hypomania.

Flouroquinolones are widely used antibiotics with side effects that involve the central nervous system. Here, we are presenting the case of a patient who developed hypomania after taking ofloxacin. The clinical features included an elevated mood, increased talkativeness, a decreased need for sleep, and drawing up big plans. The episode was circumscribed and resolved after the discontinuation of the antibiotic.

Early onset obsessive compulsive disorder with obsessive slowness: a case report and demonstration of management.

Obsessive slowness is a rare entity and is conceptualized either as primary psychiatric illness or as part of obsessive compulsive disorder (OCD). Often its outcome is frustrating even with treatment. We report a case of early onset severe OCD with obsessive slowness which showed good response to combined pharmacotherapy and behavioral therapy.