Can yoga practise prevent electro-convulsive therapy induced neurocognitive deficits? - Findings from a pilot randomised controlled trial.

Despite decades of experience with ECT, no single agent has emerged as a suitable strategy to mitigate the associated neuro-cognitive deficits. In this first of its kind pilot randomised controlled trial, we sought to demonstrate the effect of yoga on neurocognitive deficits. We found a favourable effect of Yoga in the domain of verbal fluency, however our study did not reveal significant differences in other cognitive domains. Future studies could look to build on this study while addressing the limitations cited.

Subjective Cognitive Complaints in Unaffected First-Degree Relatives of Schizophrenia Patients: Relation to Cognitive Performance, Psychotic Experiences, and Social Functioning.

Background: Neurocognitive deficits are well-documented in patients of schizophrenia and their first-degree relatives (FDRs). Metacognitive awareness of these deficits, called neurocognitive insight (NI), has been found to be poor in schizophrenia patients but has not been assessed in their FDRs. This study evaluated NI and its relationship with objective cognitive performance, a history of psychotic experiences (PEs), and social functioning in unaffected FDRs. Methods: This cross-sectional study was conducted at the outpatient department of a tertiary care teaching hospital. A total of 100 FDRs were assessed for PEs and evaluated for subjective cognitive complaints (SCC), objective cognitive performance, and social functioning using the Subjective Scale to Investigate Cognition in Schizophrenia, neurocognitive tests from the National Institute of Mental Health and Neurosciences battery, and SCARF Social Functioning Index, respectively. Results: Compared to normative data, episodic memory was the most commonly impaired domain (up to 72% of participants), followed by working memory, attention, and executive function. There was no correlation between SCC and neuropsychological test scores in the corresponding cognitive domains, implying poor NI. 15% of participants had a lifetime history of PEs. This group had significantly higher SCC as compared to those without PEs (U = 0.366, P = 0.009, r = 0.26). A regression analysis showed that the FDRs' social functioning reduced by 0.178 units for each unit increase in SCC [F (1,98) = 5.198, P = 0.025]. Conclusion: Similar to schizophrenia patients, FDRs also have poor NI. The severity and progression of SCC could be explored as a possible marker for screening and monitoring FDRs at an ultrahigh risk for psychosis. Importantly, even in unaffected FDRs, SCC could affect socio-occupational functioning and need further research.

Management of Psychiatric Disorders in Patients of Epilepsy.

Psychiatric disorders co-occur very frequently with epilepsy. This guideline covers the etiopathogenesis, presentation, evaluation and management of various psychiatric disorders in epilepsy such as mood, anxiety, psychotic and substance use disorders. It also provides an approach to important special issues in this population.

A Review of Studies Leveraging Multimodal TMS-fMRI Applications in the Pathophysiology and Treatment of Schizophrenia.

The current review provides an overview of the existing literature on multimodal transcranial magnetic stimulation, and functional magnetic resonance imaging (TMS/fMRI) studies in individuals with schizophrenia and discusses potential future avenues related to the same. Multimodal studies investigating pathophysiology have explored the role of abnormal thalamic reactivity and have provided further evidence supporting the hypothesis of schizophrenia as a disorder of aberrant connectivity and cortical plasticity. Among studies examining treatment, low-frequency rTMS for the management of persistent auditory verbal hallucinations (AVH) was the most studied. While multimodal TMS/fMRI studies have provided evidence of involvement of local speech-related and distal networks on stimulation of the left temporoparietal cortex, current evidence does not suggest the superiority of fMRI based neuronavigation over conventional methods or of active rTMS over sham for treatment of AVH. Apart from these, preliminary findings suggest a role of rTMS in treating deficits in neurocognition, social cognition, and self-agency. However, most of these studies have only examined medication-resistant symptoms and have methodological concerns arising from small sample sizes and short treatment protocols. That being said, combining TMS with fMRI appears to be a promising approach toward elucidating the pathophysiology of schizophrenia and could also open up a possibility toward developing personalized treatment for its persistent and debilitating symptoms.

Electroconvulsive therapy services during COVID-19 pandemic.

The COVID-19 pandemic has hit the electroconvulsive therapy (ECT) services hard worldwide as it is considered an elective procedure and hence has been given less importance. Other reasons include the risk of transmission of infections, lack of resources, and the scarcity of anesthesiologists due to their diversion to intensive care units to manage COVID-19 patients. However, ECT is an urgent and life-saving measure for patients diagnosed with depression and other severe mental illnesses who have suicidality, catatonia, or require a rapid therapeutic response. COVID-19 pandemic is a significant source of stress for individuals due to its impact on health, employment, and social support resulting in new-onset psychiatric illnesses and the worsening of a pre-existing disorder. Hence, a continuation of the ECT services during the COVID-19 pandemic is of paramount importance. In this narrative review, the authors from India have compiled the literature on the ECT practice during the COVID-19 pandemic related to the screening and testing protocol, necessity of personal protective equipment, modification in ECT Suite, electrical stmulus settings, and anesthesia technique modification. The authors have also shared their experiences with the ECT services provided at their institute during this pandemic. This description will help other institutes to manage the ECT services uninterruptedly and make ECT a safe procedure during the current pandemic.

Subjective cognitive complaints and its relation to objective cognitive performance, clinical profile, clinical insight, and social functioning in patients of schizophrenia: A cross-sectional study.

CONTEXT: Neurocognitive deficits are well documented in schizophrenia. Neurocognitive insight (NI), described as awareness of neurocognitive deficits, has not been evaluated in the Indian context. Its relation to clinical profile and social functioning also remains unexplored. AIMS: The aim of this study was to evaluate the subjective cognitive complaints (SCCs) and their relation to objective cognitive performance, clinical profile, clinical insight, and social functioning in patients of schizophrenia. SETTINGS AND DESIGN: This was a cross-sectional study at the outpatient department of a tertiary care teaching hospital. MATERIALS AND METHODS: One hundred individuals with schizophrenia were evaluated using Positive and Negative Syndrome Scale, Subjective Scale To Investigate Cognition in Schizophrenia, abbreviated version of Scale to Assess Unawareness in Mental Disorders, and Schizophrenia Research Foundation-Social Functioning Index. Cognitive performance was assessed using (1) Digit Span Test (attention) from Wechsler Adult Intelligence Scale, 3rd edition and (2) Passages Test (explicit memory), (3) Verbal n-back Test (working memory), and (4) Stroop Test (executive functioning) from the National Institute of Mental Health and Neuro Sciences Battery. STATISTICAL ANALYSIS: Statistical analysis was done using descriptive statistics, nonparametric tests, and Pearson's coefficient of correlation. RESULTS: Participants showed impairment in all cognitive domains. Except for working memory, there was no correlation between SCC and objective performance for other cognitive domains correspondingly, implying poor NI. Severity of psychosis and clinical insight did not have any correlation with SCC. Higher SCC correlated with poorer social functioning, especially in "occupational" and "other social roles" domains. CONCLUSIONS: Individuals with schizophrenia have poor NI. This is independent of severity of psychosis or clinical insight into illness. Socio-occupational functioning and depression should be actively enquired into when patients present with SCC.

Electroconvulsive therapy during the COVID-19 pandemic.

The COVID-19 pandemic has forced substantial changes in the practice of psychiatry, including that of electroconvulsive therapy (ECT). There is higher risk of transmission of the SARS-CoV-2 virus during ECT unless due care is taken. However, in many cases, ECT cannot be avoided. In this paper, we discuss various measures that may be adapted to reduce the risk of transmission of the virus during ECT. We also suggest certain modifications to the practice of ECT in order to achieve a balance between risks and benefits of the procedure during the pandemic.