Serum prolactin level and its correlation with psychopathology in drug free/drug naïve schizophrenia a case control study.

BACKGROUND: There is a discrepancy in literature regarding level of prolactin in drug free/ drug naïve patients with non-affective psychosis. Few earlier studies have found low levels of prolactin whereas recent studies have found high levels of prolactin when compared to controls. Most of these studies have not considered the possible confounding factors. Also ours is the first study that evaluated the correlation between psychopathology & prolactin levels after considering the confounding agents. METHOD: It was a cross sectional, hospital based case control study. Purposive sampling was done to identify the cases of schizophrenia. 59 cases and 59 controls fulfilling inclusion and exclusion criteria were taken for the study after taking consent. Socio-demographic and other relevant clinical data were collected. Scores of PANSS AND BPRS were collected on the day of admission. Blood samples were collected from 8 to 10 am in the morning. Samples were centrifuged and the serum was stored in sterile vials at minus 80° centigrade. Serum Prolactin, free T3, freeT4, Thyroid Stimulating Hormone & Cortisol levels were evaluated for both cases and controls and correlation between them and with psychopathology of cases was seen. RESULTS: Our study showed that prolactin level was increased in drug free/naïve cases of schizophrenia. Significant difference was found between T4 levels of cases and controls. No correlation was found between prolactin and psychopathology. CONCLUSION: Prolactin is increased in drug free/ drug naïve patients of schizophrenia and this is not related to confounding factors. There was no significant correlation between prolactin and psychopathology.

Chronic non-fatal Datura abuse in a patient of paranoid schizophrenia: a case report.

INTRODUCTION: A range of psychoactive substances used by patients suffering from schizophrenia varies and may include those which are fatal and may cause serious toxicity leading to death. We here present a case report of a patient suffering from paranoid schizophrenia, who was abusing Datura stramonium over a prolonged period. CASE SUMMARY: A 32 year old male presented with aggressive behaviour, irritability for 6 years and regular intake of Datura seeds for 3 years. After taking detailed history and mental status examination (MSE), diagnoses of paranoid schizophrenia and mental and behavioral disorder due to use of hallucinogen were made. He had shown improvement on standard treatment with antipsychotics. CONCLUSION: D. stramonium is recognized among emerging new psychoactive substances being used across the world. Among various theories we discuss self-medication hypothesis as a mediating factor for this case. Though D. stramonium is notorious for its life threatening sequelae, clinicians should be aware of its chronic abuse as self-medication.

Factor analysis of positive and negative syndrome scale in schizophrenia: An exploratory study.

BACKGROUND: Controversy persists with regard to how best we can categorize symptomatic dimension of Schizophrenia. Aim of the study was to compute factorial dimensions in Indian subset of schizophrenic patients and to compare them with five factor pentagonal model extracted in western studies. MATERIALS AND METHODS: 150 inpatients of Schizophrenia with acute exacerbation were subjected to PANSS rating within one week of admission and statistical calculation done based on exploratory factor analysis. RESULTS: Five factors namely negative, autistic, activation, positive and depression were extracted wherein negative factors showed highest percentage of total variance supporting five factor modal of western literature CONCLUSION: A consensus is gradually emerging regarding symptomatic dimensions of Schizophrenia.

Lithium-induced sinus node dysfunction at therapeutic serum levels.

Lithium-induced cardiotoxicity, though rare at therapeutic levels, has been reported frequently in overdoses. We report a patient who developed sinus bradycardia while being treated with lithium carbonate even though the serum lithium levels were within the therapeutic range. It reversed following withdrawal of lithium and did not reappear with subsequent treatment with valproate.

A study of contingent negative variation and post-imperative negative variation: search for state and trait electrophysiological markers in schizophrenia.

OBJECTIVE: To compare event-related potential measures, contingent negative variation and post-imperative negative variation in drug-naïve or drug-free schizophrenic patients and normal healthy controls, and to study the effect of antipsychotic medication on the above measures. METHODS: A hospital-based prospective study was conducted at Central Institute of Psychiatry, Ranchi, India. The sample constituted 31 drug-naïve or drug-free patients with schizophrenia and 31 normal healthy individuals, matched for age and gender. An S1-S2 paradigm was used, in which the warning stimulus (S1) was auditory and the target stimulus or imperative stimulus (S2) was visual. The early contingent negative variation was marked at 500 milliseconds after S1, and late contingent negative variation was marked as the negative wave just prior to S2. The post-imperative negative variation was measured as the continued negativity after S2. RESULTS: Drug-naïve and drug-free patients significantly differed from the controls on amplitudes of early and late contingent negative variations, as well as on latency of late contingent negative variation. The rate for correct classification in 80% of cases (Wilks' lambda = 0.76) was observed in measuring amplitude of late contingent negative variation only. After exposure to antipsychotic drugs, the late contingent negative variation amplitude was found to normalise in the patient group. CONCLUSION: The late contingent negative variation could be considered a state marker for schizophrenia.

Insight in schizophrenia and its association with executive functions.

BACKGROUND: Lack of insight or awareness of illness is most frequently observed in patients with schizophrenia, and it influences treatment compliance. It has been hypothesized that the frontal dysfunction may explain poor insight in schizophrenia. AIM: The purposes of the study were to assess the degree of insight in schizophrenia and to examine the association, if any, between the degree of insight and executive functions in patients with schizophrenia. MATERIALS AND METHODS: In this pre-post study, 30 patients of both sexes diagnosed to have schizophrenia were assessed with the Scale to Assess Unawareness of Mental Disorder and Wisconsin Card Sorting Test (WCST). They were assessed once at the time of admission and then at the time of their discharge. RESULTS: The study revealed that 70% of the subjects possessed poor awareness of mental disorder. There was significant improvement of insight over time. The degree of insight was significantly associated with the performance on WCST 2(nd) assessment. WCST scores were able to explain 42% of the variance in insight. CONCLUSION: Majority of schizophrenic patients possess poor insight. This poor insight is significantly associated with poor executive function. Hence poor insight may have a cognitive etiology.

Atypicality in presentation of neuroleptic malignant syndrome caused by olanzapine.

Neuroleptic malignant syndrome (NMS) is the most serious of acute neurological side effects produced by antipsychotic medication, characterized by hyperthermia, rigidity, altered consciousness and autonomic dysfunction, the prevalence of which varies from 0.4-1.4%. NMS is usually seen in treatment with high potency typical antipsychotics and very rarely with atypical antipsychotics. However, NMS cases have been reported with risperidone, clozapine, olanzapine and quetiapine. The presentations of NMS have often varied and we report another atypicality in presentation of NMS due to olanzapine use.

The role of Gateway drugs and psychosocial factors in substance dependence in Eastern India.

OBJECTIVE: Western studies have identified the gateway patterns of substance use which lead the way from the so called "Soft Drugs" (like nicotine, etc.) to the "Hard Drugs" (like Opioids) [the Gateway hypothesis]. Nicotine and alcohol have been implicated as the most common initiating drugs in studies from different places, however, studies are lacking from this region. This study was designed to find the drugs of initiation and to understand the factors for initiation, maintenance, and relapse of these substances in persons dependent on them in Eastern India. METHOD: Seventy subjects with ICD 10 DCR diagnosis of substance dependence admitted consecutively in Center for Addiction Psychiatry, Central Institute of Psychiatry (CIP), Ranchi, were taken up for the study after taking written informed consent. A semistructured questionnaire including the substance use part of Mini International Neuropsychiatric Inventory (MINI) was administered. RESULTS: Alcohol and opioids were the most common drugs of dependence but nicotine and alcohol were found to be the most common initiating drugs in both alcohol and opioid groups. Persons dependent on opioids presented earlier for treatment, with earlier development of withdrawal symptoms and having completed lesser years of formal education, and had higher monthly incomes as compared to those dependent on alcohol. The most common psychosocial factors determining initiation and maintenance were peer pressure or curiosity. CONCLUSIONS: If adolescents and youth can be motivated to stay away even from the "gateway drugs" by targeting common initiation factors, it may lead to delay in dependence or possibly avoidance of development of dependence.