Mirror finger patterns of apparent monozygotic twins and sib pairs with Schizophrenia.

BACKGROUND: Although mirror images are noted in some twins, no such reports are available for twins and subjects with schizophrenia. AIM: The study was to assess the occurrence of mirror image finger patterns in apparent monozygotic twins with schizophrenia. Another objective was to elucidate these characteristics among sib pairs with schizophrenia for comparison with those of the twins. MATERIALS AND METHODS: Eight apparent monozygotic twin pairs and eight sib pairs with schizophrenia were investigated. The frequency of identical patterns in the right side finger of one twin and the corresponding left side finger of the other twin was assessed, and similarly on other sides. Similar assessment was made in sib pairs with schizophrenia and normal sib pairs. RESULTS: The left middle finger pattern of one of the twin pair was found to be the mirror image of the right middle finger of the other twin in all the twin pairs studied and so was in seven of the sib pairs with schizophrenia. These mirror images of sib pairs with schizophrenia was more than those of normal sib pairs. This difference was accentuated with significantly more of these patterns in the twins in comparison to those among normal sib pairs. Notably, no difference emerged between the sib pairs with schizophrenia and the twins in any of their finger pairs. CONCLUSION: Mirror images that are probably due to factors like abnormal genotypes and L- DNA, appear to be promising tools to study the etiology of schizophrenia.

Finger patterns and age of onset for the determination of the parent-of-origin in the transmission of schizophrenia.

SUMMARY: Dermatoglyphic traits which are reported to be largely determined by genes could be considered as phenotypic characterestics and if the same are expressed through generations in schizophrenic families it can be speculated to serve as genetic markers for schizophrenia. Another factor that might be influenced by genes is the age of onset of the illness in the offspring and the parent of origin. OBJECTIVE: This study was aimed to elucidate the occurrence of identical finger patterns in the schizophrenic patients and their affected parents. The other objective was to assess the age of onset of the illness in them. METHODS: Forty six schizophrenic patients in whom one of the parents was also affected with schizophrenia or related disorders were recruited. Of these pairs 29 were taken up for finger patterns analysis, with an equal number of control group pairs. 35 proband and parent pairs were investigated for the age of onset of the illness. RESULTS: The frequency of occurrence of identical patterns in the right thumbs of proband and their affected mother pairs was significantly more than between the proband and their affected father pairs. Additionally, the number of identical patterns was also more in the right thumbs of proband and their affected mother pairs compared with the control group. The difference between the mean age of onset of the illness in the probands and their affected fathers was more than between the probands and their affected mothers. CONCLUSION: The genetic association of schizophrenic patients with the affected maternal side appear to be more stronger than with the paternal side.

Body dysmorphic disorder: Borderline category between neurosis and psychosis.

Body dysmorphic disorder is an under-recognized chronic problem that has been established as an independent diagnostic entity. Its clinical features, comorbidity, course, and prognosis have been studied in detail. But, the issue of its psychotic and non-psychotic variants and the question of dimensional or categorical method of classifying this disorder still pose a diagnostic dilemma. This case report tries to highlight this issue.

Judeo-Christian concepts related to psychiatry.

The behavioral manifestations of psychotic disorders that are attributed to evil spirits in the Judeo-Christian scriptures as demonstrated by Jesus Christ have been narrated. The descriptions of false beliefs and the perceptual experiences that are consistent with the psychiatric terminologies "delusions and hallucinations" are briefly discussed. Attempt has been made to analyze the patterns of suicidal behaviors, guilt feelings, and, expressions of depressive symptoms in the Jewish culture. Of interest is the mass suicide by the Jews in the 1st century AD at the Fort Masada, perhaps the first of its kind recorded in the history. Noteworthy are alcohol and related mental health problems prevalent in the Jewish culture. While highlighting the descriptions of dreams and their revelations recorded in the Bible, it is suggested that such concepts about dreams might have influenced Sigmund Freud's classical works on dreams. The biblical messages and teachings that could be applied for psychotherapy and behavior modification strategies have been outlined. The mental concepts of Jewish culture and their relevance to Indian culture have also been discussed from a cross-cultural perspective.

Klinefelter's syndrome (mosaic) with chromosome 9 inv and schizophrenia.

Klinefelter's syndrome is a sex chromosome abnormality with low androgen level. The varied manifestations of the mental symptoms in some of them, that are inexplicable based on their genotype alone, has fascinated the researchers. We present here a case of Klinefelter's syndrome having a karyotype of mos 47, XXY, and also inversion in 9(th) chromosome, with schizophrenia. Despite the view that inv 9 is a normal variant, it is still worthwhile to explore whether it has any role in the etiology of schizophrenia especially when it occurs with other genotypic aberrations that are suspected to have relevance to psychiatric disorders including the Klinefelter's syndrome.

Mode of transmission of schizophrenia.

OBJECTIVE: Although the evidences for the phenomenon of "anticipation" and parental "imprinting" have been shown in schizophrenia, they are inconclusive. The purpose of this study was to test these hypotheses by examining three successive generations. METHOD: 58 schizophrenic patients who had their maternal or paternal parent or grandparent, or both, affected with schizophrenia or related disorders were analyzed. Chi-square test was used to assess the association of the sex of the parent with more than one of the affected proband families. The differences in the age of onset of the illness between the successive three generations was calculated using the t-test. RESULTS: In comparison to mothers' affected families, a large proportion of the father side affected families had more than one of their offspring affected with the illness. The age of onset in probands was lower in comparison to that of those on the parental side and the difference was more significant when the paternal side was affected. Interestingly, when the age of onset in the grandparents was compared with either of the parental sides of the probands no difference emerged, indicating lack of support from this study for the theory of anticipation. At any rate, the age of onset of probands was significantly lower in comparison to that of the paternal grandfather side. Further, skipping of a generation in the process of transmission was noted in some families. CONCLUSIONS: It is hard to ignore our findings that suggest paternal side transmission.

Assessment of mortality and marital status of schizophrenic patients over a period of 13 years.

BACKGROUND: Studies on standardized mortality rates of schizophrenic patients might help to increase the life span of these patients. Such data from developing countries including India are lacking. Investigations that provide clues regarding the quality of their family lives could also be beneficial. AIM: Besides mortality and causes of death, this study was also aimed to examine the marital status of a group of schizophrenic patients over a period of 13 years. METHODS: Out of 121 schizophrenic patients recruited earlier for a different purpose, 60 were re-assessed after a period of 13 years with regard to their mortality and causes of death. The proportion of those who had to remain single because the onset of their illness was before they were 25 years of age were compared with those who had a later onset. RESULTS: Seven deaths were recorded and the standardized mortality ratio (SMR) for all the age groups was 54.2. One patient who had absconded was not counted as a case of death. Furthermore, this trend of a high SMR persisted despite merging both the cohort and un-reassessed group (SMR 25.1) with and without known mortality. Among the deaths, the unnatural causes of death were noteworthy (28.57%)-1 accidental and another suicidal. Some deaths were probably due to poor general medical care. The proportion of patients who had to remain single because their onset of illness was before 25 years of age was significantly more than those with a later onset (p<0.001). CONCLUSION: It is speculated that strengthening the general healthcare delivery system for the mentally ill and sensitizing caregivers about the possible risky behaviours of patients might reduce the mortality.

Bilateral Thalamic infarct with Neuropsychiatric manifestations.

Thalamic infarcts presenting predominantly with psychiatric manifestations are rather uncommon. They usually have a constellation of neurological and psychiatric symptoms involving altered consciousness, vertical gaze palsy, motor and sensory symptoms with cognitive deficits involving memory. A middle-aged male with Bilateral Thalamic infarct who presented with prominent delusions and cognitive deficits involving memory, orientation and attention despite treatment is here by reported.

Ondansetron: a selective 5-HT(3) receptor antagonist and its applications in CNS-related disorders.

Ondansetron is a selective 5-hydroxytryptamine(3) (5-HT(3)) receptor antagonist that has been introduced to clinical practice as an antiemetic for cancer treatment-induced and anesthesia-related nausea and vomiting. Its use under these circumstances is both prophylactic and therapeutic. It has a superior efficacy, safety and pharmacoeconomic profile compared with other groups of antiemetics, namely antidopaminergics, antihistamines and anticholinergics. However, its place in the management of anticipatory and delayed vomiting in cancer treatment and as a rescue antiemetic in surgical patients needs to be further explored. Furthermore, recent animal and human research also reflects its possible novel application in the treatment of other disease states, such as alcoholism, cocaine addiction, opioid withdrawal syndrome, anxiety disorders, gastrointestinal motility disorders, Tourette's syndrome and pruritus. This review revisits the widespread physiological and pathological effects of 5-HT and discusses both the basic science literature and the clinical developments responsible for the conventional and novel uses of ondansetron. In addition, new discoveries relating to the effects of ondansetron on other receptors/channels and their possible therapeutic applications are presented.

Prednisone withdrawal followed by interferon alpha for treatment of chronic hepatitis C infection: results of a randomized controlled trial.

Immunosuppressive therapy increases levels of hepatitis C virus (HCV) RNA, and when combined with interferon, corticosteroids have been reported to variably improve or have no effect on sustained response rates. We conducted a randomized double-blind placebo-controlled trial in 39 patients with biopsy-proven chronic HCV infection and elevated alanine aminotransferase levels. Patients received either 6 weeks of a tapering dose of prednisone (60 ng, 40 mg, and 20 mg in 2-week intervals) or an identical placebo. All patients then received recombinant interferon alpha-2b, 3 million units three times a week for 24 weeks. Patients were then followed for a further 24 weeks. At the end of the study there was no significant difference in the sustained biochemical response rates between the two groups (4/20 vs. 3/19, p value was not significant). Prednisone-treated patients had a significant increase in HCV RNA from baseline during steroid treatment (400 +/- 60% increase vs. -280 +/- 140% decrease; p = 0.005). Two prednisone-treated patients were withdrawn from the study secondary to serious complications related to therapy. Prednisone priming before interferon alpha therapy in patients with chronic HCV infection does not improve the sustained response rate. This therapy was associated with an increase in viral burden and significant morbidity.

Determinants of suicidal attempts of wives of substance abusers.

One hundred and fifty seven suicide attempters who were the wives of substance abusers were interviewed with the help of a self innovated proforma that was designed to explore the causative factors for their suicidal behaviour. These subjects were selected from the Intensive Medical Care Unit of Government Stanley Hospital, Chennai. Some of the family and personal problems encountered by them that were attributable to their husbands' behaviour, such as disturbed relationship with the relatives (84.7%), being manhandled by their husbands (79.5%), financial problems (76.4%) and deprivation of emotional support and love (51%), were scarecely different from those noted in other reports on attempted suicide.Nonetheless, besides the fighting behaviour of their spouses with others (58.6%), the influence of the symptoms of delusional jealousy (24.8%) and suicidal ideas (14,0%) manifested by their husbands as driving forces for their suicidal behaviour might be of specific relevance to this group of suicide attempters. The cultural influence on the behaviour of our women in response to these psychiatric symptoms of their husbands has been highlighted.

Ultracentrifugation and concentration of a large volume of serum for HCV RNA during treatment may predict sustained and relapse response in chronic HCV infection.

The ability to predict accurately a sustained response during therapy in patients with hepatitis C virus (HCV) infection is unavailable. The aim of this study was to differentiate, during therapy, patients who would relapse from those with a sustained response by ultracentrifugation for residual serum HCV RNA. Sixty-one specimens (from 32 patients) collected during interferon therapy were assessed by ultracentrifugation. All were negative using a quantitative polymerase chain reaction (PCR) (detection limit < or = 100 copies/ml). One-milliliter aliquots were ultracentrifuged at 23,000 x g (160 min), and then the nucleic acid pellet was extracted, precipitated, and resuspended. Qualitative PCR was carried out in quadruplicate using two separate 5'UTR primer sets (8 results/specimen). A specimen was positive if > or = 1 gels was positive compared to controls. At weeks 12 and 24, 9/9 (100%) sustained response patients were negative by ultracentrifugation. In the 23 relapse patients at week 12, 7/12 specimens were positive; at week 24, 7/14 were positive. Earlier time points could not differentiate the patients' eventual response to therapy. The predictive value of a positive ultracentrifugation test for relapse at week 12 or 24 was 100%. The predictive value of a negative test for sustained response was 62% and 50% at week 12 and 24, respectively. These preliminary results indicate that patients with an eventual sustained response will have no detectable serum HCV RNA by week 12 or week 24. A positive result is 100% predictive of relapse.

Relevance of sequential development of dermatoglyphics to schizophrenia.

Since the embryogeneses of epidermal ridges of hands and feet are reported to be identical, although those of the feet develop two or three weeks later, a tendency for symmetry or correspondence between each side finger and toe pairs could be envisaged. Any prenatal insult could disturb such developmental mechanisms, causing the lowering of either finger or toe ridge counts which might result in augmentation of differences between them. To test this hypothesis, the differences between each side thumb and big toe ridge counts of 89 schizophrenic patients and 65 control subjects were assessed. These samples were also subgrouped into those with and without identical pattern distributions on each side of their thumb and big toe pairs. Female schizophrenics who displayed identical patterns manifested significantly greater differences between their right thumb and big toe ridge counts in comparison to the control subjects (P = 0.0142). To elucidate the contributory digit for such a greater difference, the ridge counts of the right thumbs and big toes of the female patients were compared with the corresponding counts of the control subjects. The mean ridge count of the big toes was lesser in the patient group compared with that in the control subjects, a difference, however, that did not attain statistical significance.